Organization
TRAVELING AGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAKEITHA A. MOYE PTA (PTA)
(267) 902-7537
Entity
Organization
Contact information
Practice address
901 NE LOOP 410, SUITE 100, SAN ANTONIO, TX 78209-1305
(267) 902-7537
Mailing address
10842 GREEN LAKE ST, LOT #93, SAN ANTONIO, TX 78223-4240
(267) 902-7537
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2115702
TX
Other
Enumeration date
07/20/2016
Last updated
07/20/2016
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