Provider Demographics
NPI:1003974841
Name:MOOSE, TRICIA L (PT)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:MOOSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0725
Mailing Address - Country:US
Mailing Address - Phone:585-582-6075
Mailing Address - Fax:
Practice Address - Street 1:2000 EMPIRE BLVD BLDG 2
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1957
Practice Address - Country:US
Practice Address - Phone:585-671-1030
Practice Address - Fax:585-671-1991
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist