Provider Demographics
NPI:1942745740
Name:MOSS, WESLEY RHODES (ATC)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:RHODES
Last Name:MOSS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7311 BLUESTONE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3644
Mailing Address - Country:US
Mailing Address - Phone:210-883-7811
Mailing Address - Fax:210-458-5118
Practice Address - Street 1:1 UTSA CIR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1644
Practice Address - Country:US
Practice Address - Phone:210-458-6911
Practice Address - Fax:210-458-5115
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT41772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer