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General NPI Number Information
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NPI Number | 1487945671
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Entity Type | Individual
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Provider Name | RANDALL DEAN MOSER LMP
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Gender | Male
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 04/22/2011
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Provider Practice Location Address
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Address Line | 1018 IDAHO ST
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City | LEWISTON
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State | ID
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Zip | 83501-1938
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Country | US
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Telephone | 208-791-1019
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1958
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City | LEWISTON
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State | ID
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Zip | 83501-1464
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Country | US
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Telephone | 208-791-1019
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 581598-09
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA60111603
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License Number State | WA
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