Provider Demographics
NPI:1649399163
Name:MOSELEY, RUTH (PT)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10557 NEW CHURCH ROAD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75159
Mailing Address - Country:US
Mailing Address - Phone:214-348-3516
Mailing Address - Fax:214-358-5727
Practice Address - Street 1:10557 NEW CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75159
Practice Address - Country:US
Practice Address - Phone:214-348-3516
Practice Address - Fax:214-358-5727
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1125631208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650258Medicare ID - Type Unspecified