Basic Information
| Provider Information | |||||||||
| NPI: | 1952938839 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JESSICA MOY WELLNESS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 MASSACHUSETTS AVE APT 204 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021153511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019380572 | ||||||||
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| Practice Location | |||||||||
| Address1: | 255 MASSACHUSETTS AVE APT 204 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021153511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019380572 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2020 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | MOY | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
| AuthorizedOfficialMiddleName: | ROMERO | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3019380572 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT | ||||||||
| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.