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NPI Code Detail

MEDICARE: KATY MOSES PTA

MEDICARE: KATY MOSES PTA
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
1225200000XPhysical Therapy AssistantPTA4040AR

General Provider Information

NPI Number : 1407527120
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATY MOSES PTA
Provider Business Mailing Address
First Line : 650 S DODSON RD
Second Line :
City : ROGERS
State : AR
Zip : 72758-7015
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 650 S DODSON RD
Second Line :
City : ROGERS
State : AR
Zip : 72758-7015
Country : US
Telephone Number : 479-407-9626
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2021
Last Update Date : 09/22/2021

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Directions to “ KATY MOSES PTA” Practice Location

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