Provider Demographics
NPI:1205813789
Name:MOSHER, DANIELLE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WILLIAMSBURG PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6856
Mailing Address - Country:US
Mailing Address - Phone:526-342-6262
Mailing Address - Fax:252-353-5610
Practice Address - Street 1:201 WILLIAMSBURG PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6856
Practice Address - Country:US
Practice Address - Phone:526-342-6262
Practice Address - Fax:252-353-5610
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202352225100000X
NCP19443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010031885Medicaid
VA278179OtherANTHEM BCBS
VA010031885Medicaid