Healthcare Provider Details

I. General information

NPI: 1639476088
Provider Name (Legal Business Name): HELEN E MOSS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 RIVER DR
NORTH SIOUX CITY SD
57049-3015
US

IV. Provider business mailing address

307 MAIN ST
NORTH SIOUX CITY SD
57049-3099
US

V. Phone/Fax

Practice location:
  • Phone: 712-281-7311
  • Fax:
Mailing address:
  • Phone: 712-281-7311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number972
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: