MEDICARE: DR. JASON PAUL MOSES PT, 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	1171790	TX

General Provider Information

NPI Number	:	1730391798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON PAUL MOSES PT, DPT

Provider Business Mailing Address
First Line	:	2461 ROBINSON RD
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-3852
Country	:	US
Telephone Number	:	972-606-4858
Fax Number	:	972-606-1637

Provider Business Practice Location Address
First Line	:	2461 ROBINSON RD
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-3852
Country	:	US
Telephone Number	:	972-606-4858
Fax Number	:	972-606-1637

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	05/09/2008

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