Provider Demographics
NPI:1659505832
Name:MOSES, PAMELA LATONYA (MS)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LATONYA
Last Name:MOSES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 JULIAN RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-9079
Mailing Address - Country:US
Mailing Address - Phone:704-636-5812
Mailing Address - Fax:704-636-8373
Practice Address - Street 1:710 JULIAN RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-9079
Practice Address - Country:US
Practice Address - Phone:704-636-5812
Practice Address - Fax:704-636-8373
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist