MEDICARE: ALBERT D C MOSS PT

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
1	225100000X	Physical Therapist	6824	SC
2	225100000X	Physical Therapist	1241520	TX

General Provider Information

NPI Number	:	1235487570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT D C MOSS PT

Provider Business Mailing Address
First Line	:	6301 HARRIS PKWY
Second Line	:	STE 150
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4249
Country	:	US
Telephone Number	:	817-433-1450
Fax Number	:	817-433-1451

Provider Business Practice Location Address
First Line	:	6301 HARRIS PKWY
Second Line	:	STE 150
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4249
Country	:	US
Telephone Number	:	817-433-1450
Fax Number	:	817-433-1451

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	10/29/2014

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Directions to “ ALBERT D C MOSS PT” Practice Location

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