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NPI Code Detail

MEDICARE: STEPHANIE E MOSS PTA

MEDICARE: STEPHANIE E MOSS PTA
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 Assistant2021OK

General Provider Information

NPI Number : 1790385904
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE E MOSS PTA
Provider Business Mailing Address
First Line : 1200 CORPORATE DR
Second Line : SUITE 400
City : BIRMINGHAM
State : AL
Zip : 35242
Country : US
Telephone Number : 423-206-4158
Fax Number : 717-773-4654
Provider Business Practice Location Address
First Line : 2340 NW 32ND ST
Second Line :
City : NEWCASTLE
State : OK
Zip : 73065-6589
Country : US
Telephone Number : 405-396-3322
Fax Number : 405-392-3356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2020
Last Update Date : 10/27/2020

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Directions to “ STEPHANIE E MOSS PTA” Practice Location

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