Provider Demographics
NPI:1770650301
Name:MOSCARDI PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:MOSCARDI PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:DOMINIC
Authorized Official - Last Name:MOSCARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-481-8272
Mailing Address - Street 1:911 OAK PARK BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3406
Mailing Address - Country:US
Mailing Address - Phone:805-481-8272
Mailing Address - Fax:805-481-8045
Practice Address - Street 1:911 OAK PARK BLVD STE 105
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3406
Practice Address - Country:US
Practice Address - Phone:805-481-8272
Practice Address - Fax:805-481-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28238225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W20419Medicare PIN