# MOSHER PHYSICAL THERAPY & SPORTS MEDICINE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194702936
- **Authorized official:** MR. RUSSELL A MOSHER MSPT (PRESIDENT OWNER)
- **Authorized official phone:** (757) 789-3075

## Contact information

- **Practice address:** 712 RANDOLPH AVE, CAPE CHARLES, VA 23310-3308
- **Practice address phone:** (757) 331-4490
- **Practice address fax:** (757) 331-4491
- **Mailing address:** PO BOX 1059, ONLEY, VA 23418-1059
- **Mailing address phone:** (757) 331-4490
- **Mailing address fax:** (757) 331-4491

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 5088 | VA | Yes |

## Other

- **Enumeration date:** 12/22/2005
- **Last updated:** 08/22/2020