Provider Demographics
NPI:1972836575
Name:MOSBY, TERESA K (LMP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:K
Last Name:MOSBY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 CAPITOL BLVD SE
Mailing Address - Street 2:STE C
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5288
Mailing Address - Country:US
Mailing Address - Phone:360-878-8538
Mailing Address - Fax:
Practice Address - Street 1:6200 CAPITOL BLVD SE
Practice Address - Street 2:STE C
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5288
Practice Address - Country:US
Practice Address - Phone:360-878-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA21550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist