Healthcare Provider Details

I. General information

NPI: 1699020131
Provider Name (Legal Business Name): JAMES MOSLAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N FRONT ST
PHILIPSBURG PA
16866-8264
US

IV. Provider business mailing address

310 PENN ST SUITE 103
HOLLIDAYSBURG PA
16648-2044
US

V. Phone/Fax

Practice location:
  • Phone: 814-342-3930
  • Fax: 814-342-3935
Mailing address:
  • Phone: 814-695-2923
  • Fax: 814-695-2924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT022194
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: