Provider Demographics
NPI:1255631859
Name:MOSES, JEREMY CHRISTOPHER (DPT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:CHRISTOPHER
Last Name:MOSES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 SWAN LAKE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9707
Mailing Address - Country:US
Mailing Address - Phone:319-334-5155
Mailing Address - Fax:319-334-6166
Practice Address - Street 1:2300 SWAN LAKE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9707
Practice Address - Country:US
Practice Address - Phone:319-334-5155
Practice Address - Fax:319-334-6166
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist