Provider Demographics
NPI:1780867671
Name:MOSS, LARRY (PT, CFP)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MOSS
Suffix:
Gender:M
Credentials:PT, CFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 CHRISTINA CIR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-0649
Mailing Address - Country:US
Mailing Address - Phone:775-626-0686
Mailing Address - Fax:
Practice Address - Street 1:2225 N MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-3365
Practice Address - Country:US
Practice Address - Phone:775-359-1199
Practice Address - Fax:775-359-1195
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV265174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003416275Medicaid