Provider Demographics
NPI:1487885620
Name:MOSLEY, TAMMY ANN (PT)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:ANN
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:ANN
Other - Last Name:BEARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9171 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3944
Mailing Address - Country:US
Mailing Address - Phone:410-480-3705
Mailing Address - Fax:410-480-3707
Practice Address - Street 1:9171 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:SUITE 120
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3944
Practice Address - Country:US
Practice Address - Phone:410-480-3705
Practice Address - Fax:410-480-3707
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD384812Y5FMedicare PIN