Provider Demographics
NPI:1275184400
Name:MOSES, JOANNA LYNN
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:LYNN
Last Name:MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:LYNN
Other - Last Name:SCAMMAHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:303 S MISSION ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-6142
Mailing Address - Country:US
Mailing Address - Phone:512-497-9198
Mailing Address - Fax:
Practice Address - Street 1:6 1ST ST STE 12
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2247
Practice Address - Country:US
Practice Address - Phone:512-497-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60860591225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist