Provider Demographics
NPI:1508812082
Name:MOSSBERG, GUNNAR TORSTEN (MOMT DPT FAOMPT)
Entity type:Individual
Prefix:MR
First Name:GUNNAR
Middle Name:TORSTEN
Last Name:MOSSBERG
Suffix:
Gender:M
Credentials:MOMT DPT FAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9855 ERMA RD
Mailing Address - Street 2:#106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3001
Mailing Address - Country:US
Mailing Address - Phone:858-549-7111
Mailing Address - Fax:858-549-9240
Practice Address - Street 1:9855 ERMA RD
Practice Address - Street 2:#106
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3001
Practice Address - Country:US
Practice Address - Phone:858-549-7111
Practice Address - Fax:858-549-9240
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W16384Medicare ID - Type Unspecified
R36082Medicare UPIN