Provider Demographics
NPI:1366527715
Name:MOZINGO, VIRGINIA (MPT)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:MOZINGO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 PENCO ROAD
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062
Mailing Address - Country:US
Mailing Address - Phone:304-723-3780
Mailing Address - Fax:304-723-4110
Practice Address - Street 1:1114 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:WV
Practice Address - Zip Code:26047-9537
Practice Address - Country:US
Practice Address - Phone:304-564-1098
Practice Address - Fax:304-564-5020
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV55071930000OtherWV WORKERS COMP BRICKSTRE
WV55071930003OtherTHE HEALTH PLAN BWC
WV0014417000Medicaid
WV0863932Medicare PIN
WV0863933Medicare PIN
WV55071930003OtherTHE HEALTH PLAN BWC