MEDICARE: LESLIE ERIN MOSKAL DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	30946	FL

General Provider Information

NPI Number	:	1295196822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ERIN MOSKAL DPT

Provider Business Mailing Address
First Line	:	754 VINTAGE CIR
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-1647
Country	:	US
Telephone Number	:	850-543-1812
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 W HEWETT RD
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-3310
Country	:	US
Telephone Number	:	850-278-3821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2016
Last Update Date	:	03/09/2016

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