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General NPI Number Information
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NPI Number | 1942061759
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Entity Type | Individual
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Provider Name | MOESHA PAULING PTA
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Gender | Female
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Dates
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Enumeration Date | 01/18/2024
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Last Update Date | 01/21/2024
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Provider Practice Location Address
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Address Line | 1616 RABON FARMS LN
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City | COLUMBIA
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State | SC
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Zip | 29223-5879
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Country | US
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Telephone | 803-602-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 2190 OLD CAMDEN RD
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City | WINNSBORO
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State | SC
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Zip | 29180-8878
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Country | US
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Telephone | 803-206-0387
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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 | 5094
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License Number State | SC
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