Provider Demographics
NPI:1568633014
Name:MOSS, LAURA FOX (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:FOX
Last Name:MOSS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JEAN
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:450 WARD ST EXT
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-848-7859
Mailing Address - Fax:
Practice Address - Street 1:450 WARD ST EXT
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-848-7859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist