Provider Demographics
NPI:1952938839
Name:JESSICA MOY WELLNESS LLC
Entity Type:Organization
Organization Name:JESSICA MOY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ROMERO
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:301-938-0572
Mailing Address - Street 1:255 MASSACHUSETTS AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3511
Mailing Address - Country:US
Mailing Address - Phone:301-938-0572
Mailing Address - Fax:
Practice Address - Street 1:255 MASSACHUSETTS AVE APT 204
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-3511
Practice Address - Country:US
Practice Address - Phone:301-938-0572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy