Provider Demographics
NPI:1043462906
Name:MOSHKOVICH, LEONID (PTA)
Entity Type:Individual
Prefix:MR
First Name:LEONID
Middle Name:
Last Name:MOSHKOVICH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E CORRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7524
Mailing Address - Country:US
Mailing Address - Phone:907-260-5893
Mailing Address - Fax:
Practice Address - Street 1:108 E CORRAL AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7524
Practice Address - Country:US
Practice Address - Phone:907-260-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1455225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant