Provider Demographics
NPI:1609611763
Name:ZETTLEMOYER, MYA
Entity type:Individual
Prefix:
First Name:MYA
Middle Name:
Last Name:ZETTLEMOYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYA
Other - Middle Name:
Other - Last Name:ZETTLEMOYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2049 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5043
Mailing Address - Country:US
Mailing Address - Phone:610-739-6701
Mailing Address - Fax:
Practice Address - Street 1:2049 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5043
Practice Address - Country:US
Practice Address - Phone:610-739-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer