Provider Demographics
NPI:1043402605
Name:MOSCOSO, NEIL I (RPT)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:I
Last Name:MOSCOSO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 COLLINS RD
Mailing Address - Street 2:APT. 1111
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5879
Mailing Address - Country:US
Mailing Address - Phone:619-701-2040
Mailing Address - Fax:
Practice Address - Street 1:11565 HARTS RD
Practice Address - Street 2:THERAPY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-3777
Practice Address - Country:US
Practice Address - Phone:904-751-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 23106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist