Basic Information
| Provider Information | |||||||||
| NPI: | 1649797002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOY | ||||||||
| FirstName: | JESSICA | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 654 BEACON ST | ||||||||
| Address2: | STE 2 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022152099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175361161 | ||||||||
| FaxNumber: | 6175361165 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 WATER ST | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019380572 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2017 | ||||||||
| LastUpdateDate: | 07/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 2251X0800X | 23617 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.