Healthcare Provider Details

I. General information

NPI: 1215250352
Provider Name (Legal Business Name): ASHLEY L MOSS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S HANOVER ST
HUMMELSTOWN PA
17036-2625
US

IV. Provider business mailing address

480 WALTON AVE APT 1
HUMMELSTOWN PA
17036-1845
US

V. Phone/Fax

Practice location:
  • Phone: 717-566-5312
  • Fax:
Mailing address:
  • Phone: 717-525-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004213
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: