Provider Demographics
NPI:1871823419
Name:MOSER-GOODWILL, TESSA L (MPT)
Entity Type:Individual
Prefix:MS
First Name:TESSA
Middle Name:L
Last Name:MOSER-GOODWILL
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 1:6048 SIERRA LAKES ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-6853
Mailing Address - Country:US
Mailing Address - Phone:702-526-8181
Mailing Address - Fax:
Practice Address - Street 1:6048 SIERRA LAKES ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-6853
Practice Address - Country:US
Practice Address - Phone:702-526-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist