MEDICARE: RICHARD DALE MOCABEE P.T.

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	2305004267	VA

General Provider Information

NPI Number	:	1548237878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD DALE MOCABEE P.T.

Provider Business Mailing Address
First Line	:	6 THIMBLE SHOALS CT
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23664-1153
Country	:	US
Telephone Number	:	757-851-3640
Fax Number	:

Provider Business Practice Location Address
First Line	:	11842 ROCK LANDING DR
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4437
Country	:	US
Telephone Number	:	757-591-2022
Fax Number	:	757-591-2075

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	07/08/2007

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