Provider Demographics
NPI:1619594199
Name:MOSER, MATTHEW REYMAR
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:REYMAR
Last Name:MOSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S MORRISON ST APT 5
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:871 RIDGEWAY LOOP RD STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4026
Practice Address - Country:US
Practice Address - Phone:901-221-9221
Practice Address - Fax:901-221-9222
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist