Provider Demographics
NPI:1386663698
Name:MOSESSON, JAY FORREST (PT, DPT, CERT MDT)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:FORREST
Last Name:MOSESSON
Suffix:
Gender:M
Credentials:PT, DPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 LEGEND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-6122
Mailing Address - Country:US
Mailing Address - Phone:919-360-6038
Mailing Address - Fax:919-590-1958
Practice Address - Street 1:1717 LEGION RD
Practice Address - Street 2:STE 102
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2396
Practice Address - Country:US
Practice Address - Phone:919-360-6038
Practice Address - Fax:919-590-1958
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16003225100000X
NCPT11595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP11595OtherNC PT LICENCE
CAPT16003OtherCA PT LICENCE
OPT160031Medicare PIN