Individual
CLARENCE J MOSS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1196
(864) 512-3719
Mailing address
PO BOX 100174, COLUMBIA, SC 29202-3174
(864) 512-1417
(864) 512-3719
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4358
SC
225100000X
Physical Therapist
PT002016
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003146226A
—
GA
01
—
NPI #
MEDCOST
GA
Enumeration date
07/01/2013
Last updated
03/12/2018
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