Basic Information
| Provider Information | |||||||||
| NPI: | 1174576623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSES | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PALMERI-PARKIN | ||||||||
| OtherFirstName: | CYNTHIA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 255 ENTERPRISE BLVD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296156300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644540888 | ||||||||
| FaxNumber: | 8644541130 | ||||||||
| Practice Location | |||||||||
| Address1: | 3851 HOWARD GAP RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287923102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644546670 | ||||||||
| FaxNumber: | 8644546675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P8677 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 5263 | SC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 20-2312101 | 01 | SELECT HEALTH | OTHER | 607756102 | 01 | SC | DEPT OF LABOR | OTHER | 190244 | 01 | SC | MEDCOST | OTHER | 20-2312101 | 01 | SC | UHC | OTHER | 20-2312101 | 01 | SC | GREAT WEST | OTHER | 20-2312101 | 01 | SC | FOCUS | OTHER | 20-2312101 | 01 | SC | CHAMPUS-TRICARE | OTHER | 20-2312101 | 01 | SC | DEPT OF LABOR | OTHER | 20-2312101 | 01 | SC | KANAWHA | OTHER | 9799717 | 01 | SC | CIGNA | OTHER | 20-2312101 | 01 | SC | TAX ID | OTHER | 607756100 | 01 | SC | DEPT OF LABOR | OTHER | 7761758 | 01 | SC | AETNA | OTHER | 20-2312101 | 01 | SC | BLUECHOICE | OTHER | TH1709 | 05 | SC | MEDICAID | 20-2312101 | 01 | SC | BCBS OF SOUTH CAROLINA | OTHER | 607756103 | 01 | SC | DEPT OF LABOR | OTHER | 20-2312101 | 01 | SC | PREMIER | OTHER | 20-2312101 | 01 | SC | CAROLINA CARE PLAN | OTHER |