Provider Demographics
NPI:1740676485
Name:MOSES, MARC (PT)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MOSES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HINKLE DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-0739
Mailing Address - Country:US
Mailing Address - Phone:940-383-6343
Mailing Address - Fax:940-898-8874
Practice Address - Street 1:2500 HINKLE DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-0739
Practice Address - Country:US
Practice Address - Phone:940-383-6343
Practice Address - Fax:940-898-8874
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1042455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist