Provider Demographics
NPI:1629562236
Name:MOSELEY, SPENCER REID
Entity Type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:REID
Last Name:MOSELEY
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 1:285 HYDRAULIC RIDGE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8126
Mailing Address - Country:US
Mailing Address - Phone:434-817-0980
Mailing Address - Fax:
Practice Address - Street 1:285 HYDRAULIC RIDGE RD STE 4
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8126
Practice Address - Country:US
Practice Address - Phone:434-817-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052120572251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic