Provider Demographics
NPI:1689655227
Name:ROSE, MOYA C (MPT)
Entity Type:Individual
Prefix:
First Name:MOYA
Middle Name:C
Last Name:ROSE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MOYA
Other - Middle Name:CR
Other - Last Name:REUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 WASON AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1140
Mailing Address - Country:US
Mailing Address - Phone:413-887-5130
Mailing Address - Fax:413-733-1924
Practice Address - Street 1:101 WASON AVE FL 3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1140
Practice Address - Country:US
Practice Address - Phone:413-887-5130
Practice Address - Fax:413-733-1924
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist