Provider Demographics
NPI:1235364548
Name:MOSS, CHRISTINE PATRESE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:PATRESE
Last Name:MOSS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:PATRESE
Other - Last Name:NASCIMENTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:36 LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:917-744-3199
Mailing Address - Fax:
Practice Address - Street 1:8453 251ST ST
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-2114
Practice Address - Country:US
Practice Address - Phone:917-744-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-17
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027458225100000X
NY027458-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist