Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 01327 | MD |
NPI | 1154453876 |
---|---|
Provider Name | Dr. Gabriella Prochaska Moss |
First Address | Olney, MD 20832-1479 |
Second Address | Olney, MD 20832-1479 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/04/2013 |