Provider Demographics
NPI:1225158058
Name:MOSS REHABILTATION CENTER, LLP
Entity Type:Organization
Organization Name:MOSS REHABILTATION CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, COMT
Authorized Official - Phone:817-220-6677
Mailing Address - Street 1:407 OLD SPRINGTOWN RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SPRINGTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:76082-2773
Mailing Address - Country:US
Mailing Address - Phone:817-220-6677
Mailing Address - Fax:
Practice Address - Street 1:407 OLD SPRINGTOWN RD
Practice Address - Street 2:SUITE 114
Practice Address - City:SPRINGTOWN
Practice Address - State:TX
Practice Address - Zip Code:76082-2773
Practice Address - Country:US
Practice Address - Phone:817-220-6677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11250032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0030NNOtherBLUE CROSS BLUE SHIELD
TX0030NNOtherBLUE CROSS BLUE SHIELD