Healthcare Provider Details

I. General information

NPI: 1225641582
Provider Name (Legal Business Name): JOSEPH BRANDON MOSER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 W CHESTNUT ST
ROGERS AR
72756-0351
US

IV. Provider business mailing address

620 W LAFAYETTE ST APT 22
FAYETTEVILLE AR
72701-4129
US

V. Phone/Fax

Practice location:
  • Phone: 479-246-0101
  • Fax:
Mailing address:
  • Phone: 201-716-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4581
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: