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NPI Code Detail

MEDICARE: SAMANTHA ANN MOSKOFF

MEDICARE: SAMANTHA ANN MOSKOFF
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
1225200000XPhysical Therapy Assistant160008075IL

General Provider Information

NPI Number : 1437891942
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ANN MOSKOFF
Provider Business Mailing Address
First Line : 1505 JESSICA LN
Second Line :
City : HERRIN
State : IL
Zip : 62948-4373
Country : US
Telephone Number : 618-927-2208
Fax Number :
Provider Business Practice Location Address
First Line : 120 N TOWER RD
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-1929
Country : US
Telephone Number : 618-549-3355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2022
Last Update Date : 04/13/2022

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