Provider Demographics
NPI:1699752618
Name:MOSLEY, LYNN LIBERTE (PT)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:LIBERTE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-8903
Mailing Address - Country:US
Mailing Address - Phone:205-384-1941
Mailing Address - Fax:
Practice Address - Street 1:2980 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8903
Practice Address - Country:US
Practice Address - Phone:205-384-1941
Practice Address - Fax:205-384-6362
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00101318OtherRAILROAD MEDICARE
AL000094084Medicaid
AL051094084OtherBCBS OF ALABAMA
ALP00101318OtherRAILROAD MEDICARE
AL0879600001Medicare NSC
AL000094084Medicaid