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General NPI Number Information
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NPI Number | 1730320755
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Entity Type | Individual
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Provider Name | GAOLATLHE MOYAMBO PT
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Gender | Male
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Dates
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Enumeration Date | 03/21/2009
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Last Update Date | 03/21/2009
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Provider Practice Location Address
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Address Line | 1900 PINE ST
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City | ABILENE
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State | TX
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Zip | 79601-2432
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Country | US
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Telephone | 325-670-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 101 WILDFLOWER BLVD
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City | MARBLE FALLS
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State | TX
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Zip | 78654-5173
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Country | US
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Telephone | 512-785-5295
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1108744
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00562300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT13055
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License Number State | FL
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