Healthcare Provider Details

I. General information

NPI: 1366527715
Provider Name (Legal Business Name): VIRGINIA MOZINGO MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 RIDGE AVE
NEW CUMBERLAND WV
26047-9537
US

IV. Provider business mailing address

414 PENCO ROAD
WEIRTON WV
26062
US

V. Phone/Fax

Practice location:
  • Phone: 304-564-1098
  • Fax: 304-564-5020
Mailing address:
  • Phone: 304-723-3780
  • Fax: 304-723-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001539
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: