=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083760177
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISSA MARIE MOISE DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 280 MAIN ST NCHA - SUITE 210A
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03060-2919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-577-3050
-----------------------------------------------------
Fax | 603-577-3062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 280 MAIN ST NCHA - SUITE 210A
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03060-2919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-577-3050
-----------------------------------------------------
Fax | 603-577-3062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2989
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 16768
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------