Provider Demographics
NPI:1467480509
Name:MOSS, CHRISTOPHER J (DHSC, ATC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:MOSS
Suffix:
Gender:M
Credentials:DHSC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 E GRACE ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-3211
Mailing Address - Country:US
Mailing Address - Phone:219-866-5141
Mailing Address - Fax:219-866-3619
Practice Address - Street 1:13102 S 50 E
Practice Address - Street 2:
Practice Address - City:KENTLAND
Practice Address - State:IN
Practice Address - Zip Code:47951-8540
Practice Address - Country:US
Practice Address - Phone:219-474-5167
Practice Address - Fax:219-474-6592
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT00000008522255A2300X
IN36000089A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer