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Individual
VADONNA G MOFFETT
Active
Individual
VADONNA G MOFFETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4399700
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4115301
BCBST PROVIDER NUMBER
TN
Enumeration date
08/31/2006
Last updated
07/08/2007
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