Provider Demographics
NPI:1467789305
Name:MOSS, REBECCA LEA (PT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEA
Last Name:MOSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LEA
Other - Last Name:LITTLEFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:819 WATER ST
Mailing Address - Street 2:STE 300
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5333
Mailing Address - Country:US
Mailing Address - Phone:830-258-5430
Mailing Address - Fax:830-792-5771
Practice Address - Street 1:819 WATER ST
Practice Address - Street 2:STE 300
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5333
Practice Address - Country:US
Practice Address - Phone:830-258-5430
Practice Address - Fax:830-792-5771
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1162133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1162133OtherPT LICENSE