Provider Demographics
NPI:1326622259
Name:MOSLEY, LEMAR (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:LEMAR
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6575 W TROPICANA AVE APT 2052
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4743
Mailing Address - Country:US
Mailing Address - Phone:646-335-2845
Mailing Address - Fax:
Practice Address - Street 1:1475 RAIDERS WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4604
Practice Address - Country:US
Practice Address - Phone:725-780-3401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05063472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer