Provider Demographics
NPI:1366603912
Name:LE BLANC, MOUSLY ALMOZA (MD)
Entity type:Individual
Prefix:DR
First Name:MOUSLY
Middle Name:ALMOZA
Last Name:LE BLANC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOUSLY
Other - Middle Name:
Other - Last Name:ALMOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 LOMBARD STREET
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1414
Mailing Address - Country:US
Mailing Address - Phone:215-662-3259
Mailing Address - Fax:
Practice Address - Street 1:1800 LOMBARD STREET
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1414
Practice Address - Country:US
Practice Address - Phone:215-662-3259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446338208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation