Provider Demographics
NPI:1235581463
Name:MOSES, LIANE ELIZABETH
Entity Type:Individual
Prefix:DR
First Name:LIANE
Middle Name:ELIZABETH
Last Name:MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CRAFTS ST STE 570
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1282
Mailing Address - Country:US
Mailing Address - Phone:617-965-8070
Mailing Address - Fax:
Practice Address - Street 1:29 CRAFTS ST STE 570
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02458-1282
Practice Address - Country:US
Practice Address - Phone:617-965-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA462262345OtherWELLBRIDGE PHYSICAL THERAPY TAX IDENTIFICATION NUMBER