Provider Demographics
NPI:1942433776
Name:MOSCHELLA, MICHAEL (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MOSCHELLA
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SHAWS CV
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4969
Mailing Address - Country:US
Mailing Address - Phone:860-447-3009
Mailing Address - Fax:860-447-1320
Practice Address - Street 1:6 SHAWS CV
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4969
Practice Address - Country:US
Practice Address - Phone:860-447-3009
Practice Address - Fax:860-447-1320
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist