Provider Demographics
NPI:1942061759
Name:PAULING, MOESHA (PTA)
Entity Type:Individual
Prefix:
First Name:MOESHA
Middle Name:
Last Name:PAULING
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 OLD CAMDEN RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-8878
Mailing Address - Country:US
Mailing Address - Phone:803-206-0387
Mailing Address - Fax:
Practice Address - Street 1:1616 RABON FARMS LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5879
Practice Address - Country:US
Practice Address - Phone:803-602-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5094225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant