Provider Demographics
NPI:1073529152
Name:MOSES, ADRIAN JAMES (MPT)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:JAMES
Last Name:MOSES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 GRAND CENTRAL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-1079
Mailing Address - Country:US
Mailing Address - Phone:304-693-2781
Mailing Address - Fax:304-693-2171
Practice Address - Street 1:1216 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-2315
Practice Address - Country:US
Practice Address - Phone:304-907-0227
Practice Address - Fax:304-907-2730
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7303127000Medicaid
P00194835OtherRAILROAD MEDICARE
OH2447472Medicaid
P00194835OtherRAILROAD MEDICARE