1982716445 NPI number — MS. MARJORIE ANN MOSHER PT, DPT, MTC

Table of content: MS. MARJORIE ANN MOSHER PT, DPT, MTC (NPI 1982716445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982716445 NPI number — MS. MARJORIE ANN MOSHER PT, DPT, MTC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSHER
Provider First Name:
MARJORIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, MTC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982716445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8823 PRODUCTION LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OOLTEWAH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37363-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-238-7217
Provider Business Mailing Address Fax Number:
423-362-8684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 JOHNSON FERRY RD
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30068-5418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-565-3201
Provider Business Practice Location Address Fax Number:
770-565-3203
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT004043 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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