Provider Demographics
NPI:1619477593
Name:MOSSBARGER, GARRETT (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:MOSSBARGER
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 BELLAIRE DR S APT 240
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-5171
Mailing Address - Country:US
Mailing Address - Phone:480-980-8145
Mailing Address - Fax:
Practice Address - Street 1:3001 FOREST PARK BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-2828
Practice Address - Country:US
Practice Address - Phone:480-980-8145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT57072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer