Provider Demographics
NPI:1073564886
Name:MOSSBERG & ASSOCIATES PHYSCIAL THERAPY INC
Entity Type:Organization
Organization Name:MOSSBERG & ASSOCIATES PHYSCIAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUNNAR
Authorized Official - Middle Name:TORSTEN
Authorized Official - Last Name:MOSSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-549-7111
Mailing Address - Street 1:9855 ERMA RD
Mailing Address - Street 2:STE 106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131
Mailing Address - Country:US
Mailing Address - Phone:858-549-7111
Mailing Address - Fax:858-549-9240
Practice Address - Street 1:9855 ERMA RD
Practice Address - Street 2:STE 106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131
Practice Address - Country:US
Practice Address - Phone:858-549-7111
Practice Address - Fax:858-549-9240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W16384Medicare ID - Type Unspecified
R36082Medicare UPIN