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NPI Code Detail

MEDICARE: AMANDA MOISAN DPT

MEDICARE: AMANDA MOISAN DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1259189TX

General Provider Information

NPI Number : 1225412067
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA MOISAN DPT
Provider Business Mailing Address
First Line : 3003 N A ST
Second Line :
City : MIDLAND
State : TX
Zip : 79705-5304
Country : US
Telephone Number : 432-618-9952
Fax Number : 432-618-9953
Provider Business Practice Location Address
First Line : 3003 N A ST
Second Line :
City : MIDLAND
State : TX
Zip : 79705-5304
Country : US
Telephone Number : 432-618-9952
Fax Number : 432-618-9953
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2015
Last Update Date : 07/10/2015

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Directions to “ AMANDA MOISAN DPT” Practice Location

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