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Individual
MRS. TECKLA P MOULTON
Active
Individual
MRS. TECKLA P MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2668
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0397903
—
MA
01
—
MOY65938
BLUE CROSS
MA
Enumeration date
02/15/2007
Last updated
12/21/2007
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