Provider Demographics
NPI:1437146875
Name:MOSS, BRITTON DEREK (PT)
Entity Type:Individual
Prefix:MR
First Name:BRITTON
Middle Name:DEREK
Last Name:MOSS
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 1:500 W FIR ST
Mailing Address - Street 2:STE A
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3201
Mailing Address - Country:US
Mailing Address - Phone:318-322-7050
Mailing Address - Fax:318-322-7031
Practice Address - Street 1:105 BLANCHARD ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7369
Practice Address - Country:US
Practice Address - Phone:318-398-9940
Practice Address - Fax:318-398-9975
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60456897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist