Provider Demographics
NPI:1710162458
Name:MOSES, BELINDA (LMT)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:
Last Name:MOSES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 NE DEWEY DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1357
Mailing Address - Country:US
Mailing Address - Phone:541-218-5769
Mailing Address - Fax:541-476-7519
Practice Address - Street 1:760 NE DEWEY DR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1357
Practice Address - Country:US
Practice Address - Phone:541-218-5769
Practice Address - Fax:541-476-7519
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#12336225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist