Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 226300000X | Kinesiotherapist |
NPI | 1477148591 |
---|---|
Provider Name | Thomas Moss |
First Address | Petal, MS 39465-9279 |
Second Address | Petal, MS 39465-9279 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2021 |
Last Update Date | 01/11/2021 |