Provider Demographics
NPI:1417972977
Name:MOSCARDI, LOUIS DOMINIC (PT)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:DOMINIC
Last Name:MOSCARDI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 OAK PARK BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3406
Mailing Address - Country:US
Mailing Address - Phone:805-481-8272
Mailing Address - Fax:805-481-8045
Practice Address - Street 1:911 OAK PARK BLVD STE 105
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3406
Practice Address - Country:US
Practice Address - Phone:805-481-8272
Practice Address - Fax:805-481-8045
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT28238BMedicare PIN