Provider Demographics
NPI:1073137063
Name:MOSES AND JOHNSON THERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:MOSES AND JOHNSON THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-801-7448
Mailing Address - Street 1:265 N WILLETT ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-5117
Mailing Address - Country:US
Mailing Address - Phone:901-244-3800
Mailing Address - Fax:901-244-3900
Practice Address - Street 1:256 GERMANTOWN BEND CV STE 102
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-5212
Practice Address - Country:US
Practice Address - Phone:901-522-6671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty