Basic Information
| Provider Information | |||||||||
| NPI: | 1104474170 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSS | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 CORPORATE DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352425424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232388930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 CUMBERLAND PLZ | ||||||||
| Address2: | |||||||||
| City: | CROSSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385554292 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317871244 | ||||||||
| FaxNumber: | 9317871245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2019 | ||||||||
| LastUpdateDate: | 09/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 7145 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.