Provider Demographics
NPI:1831464106
Name:MOSES, BILL EUGENE JR (PTA)
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:EUGENE
Last Name:MOSES
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 CREEKSTONE CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-6965
Mailing Address - Country:US
Mailing Address - Phone:828-777-2869
Mailing Address - Fax:
Practice Address - Street 1:111 HARRILSON RD
Practice Address - Street 2:
Practice Address - City:CHERRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28021-9541
Practice Address - Country:US
Practice Address - Phone:704-435-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4662225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant