Provider Demographics
NPI:1467671586
Name:MOSER, TODD M (PTA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:MOSER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:TODD
Other - Middle Name:
Other - Last Name:MOSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:4212 WOODCREST AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2257
Mailing Address - Country:US
Mailing Address - Phone:307-638-3988
Mailing Address - Fax:
Practice Address - Street 1:5307 YELLOWSTONE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4736
Practice Address - Country:US
Practice Address - Phone:307-632-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0254225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant