MEDICARE: MR. CHARLES HENRY MOSELEY III MPT, OCS, CSCS

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	9306	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7866	OTHER	NC	BLUE CROSS

General Provider Information

NPI Number	:	1598716789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES HENRY MOSELEY III MPT, OCS, CSCS

Provider Business Mailing Address
First Line	:	4030 WAKE FOREST RD 211
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6800
Country	:	US
Telephone Number	:	919-872-2828
Fax Number	:	919-872-8138

Provider Business Practice Location Address
First Line	:	4030 WAKE FOREST RD 211
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6800
Country	:	US
Telephone Number	:	919-872-2828
Fax Number	:	919-872-8138

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

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	10/30/2015

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