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Individual
MR. RUSSELL A MOSHER
Active
Individual
MR. RUSSELL A MOSHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2305202353
VA
225100000X
Physical Therapist
Primary
DAPT003608
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010031923
—
VA
01
—
278178
ANTHEM BCBS
VA
Enumeration date
12/22/2005
Last updated
01/19/2017
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