MEDICARE: JEFF SCOTT MOSES PHYSICAL THERAPIST

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	2818	OK

General Provider Information

NPI Number	:	1316994189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF SCOTT MOSES PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	PO BOX 512
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-0512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 N BRADLEY ST
Second Line	:
City	:	WEATHERFORD
State	:	OK
Zip	:	73096-5229
Country	:	US
Telephone Number	:	580-772-2662
Fax Number	:

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/08/2007

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