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General NPI Number Information
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NPI Number | 1386018521
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Entity Type | Individual
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Provider Name | MOISES JOSHUA ALBANO
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Gender | Male
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Dates
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Enumeration Date | 11/27/2015
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Last Update Date | 11/27/2015
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Provider Practice Location Address
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Address Line | 3115 N SYCAMORE DR
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City | BOISE
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State | ID
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Zip | 83703-4129
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Country | US
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Telephone | 208-343-7726
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Fax |
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Provider Business Mailing Address
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Address Line | 25117 SW PARKWAY AVE STE D
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City | WILSONVILLE
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State | OR
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Zip | 97070-9697
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Country | US
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Telephone | 877-407-3422
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA-3098
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License Number State | ID
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