Provider Demographics
NPI:1710044631
Name:MOSS, JUDITH CHRISTINE (MPT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CHRISTINE
Last Name:MOSS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8313 HADDON DR
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-7322
Mailing Address - Country:US
Mailing Address - Phone:202-271-8545
Mailing Address - Fax:
Practice Address - Street 1:6900 GEORGIA AVE., NW
Practice Address - Street 2:WALTER REED ARMY MEDICAL CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307
Practice Address - Country:US
Practice Address - Phone:202-271-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist