Provider Demographics
NPI:1043802838
Name:MOSLEY, ANTHONY JR
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:MOSLEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 N RANCHO DR STE 109
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3151
Mailing Address - Country:US
Mailing Address - Phone:702-848-1411
Mailing Address - Fax:702-848-1711
Practice Address - Street 1:3650 N RANCHO DR STE 109
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3151
Practice Address - Country:US
Practice Address - Phone:702-848-1411
Practice Address - Fax:702-848-1711
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner