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Individual

MICAH MOEAI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.S., ATC

Contact information

Practice address
1151 HOSPITAL WAY, BLD D, STE 100, POCATELLO, ID 83202
(808) 277-3706
Mailing address
1151 HOSPITAL WAY, BLD D, STE 100, POCATELLO, ID 83201-5091
(208) 239-8010

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
8706704-4810
UT

Other

Enumeration date
06/20/2013
Last updated
04/29/2014
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