Individual
TONY C MOFFETT SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6047 STILL MDW, SAN ANTONIO, TX 78222-3425
(979) 402-7937
Mailing address
6047 STILL MDW, SAN ANTONIO, TX 78222-3425
(979) 402-7937
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
—
—
Other
Enumeration date
07/17/2018
Last updated
07/17/2018
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