Provider Demographics
NPI:1952336109
Name:MOISON, JAMES G (CNMT, LMT, CPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:MOISON
Suffix:
Gender:M
Credentials:CNMT, LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 ARROWHEAD DR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-1903
Mailing Address - Country:US
Mailing Address - Phone:727-641-4634
Mailing Address - Fax:
Practice Address - Street 1:259 4TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2911
Practice Address - Country:US
Practice Address - Phone:727-641-4634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA32085225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist