Provider Demographics
NPI:1609398296
Name:MOSS, MONICA GVOICH (DPT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:GVOICH
Last Name:MOSS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MONIC
Other - Middle Name:DAWN
Other - Last Name:GVOICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-7735
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:7777 HENNESSY BLVD STE 709
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4366
Practice Address - Country:US
Practice Address - Phone:225-765-7735
Practice Address - Fax:225-765-9937
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist