Provider Demographics
NPI:1477929685
Name:MOSER, AMBER FULFORD (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:FULFORD
Last Name:MOSER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10420 MCKINLEY DR APT 6107
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6441
Mailing Address - Country:US
Mailing Address - Phone:912-256-3389
Mailing Address - Fax:
Practice Address - Street 1:6601 SUGARLOAF PKWY STE 230
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4936
Practice Address - Country:US
Practice Address - Phone:770-814-3900
Practice Address - Fax:770-814-3009
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012060225100000X
FLPT39707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist