Individual
HALEY MOSCOSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
140 S BEACH ST, DAYTONA BEACH, FL 32114-4472
(386) 898-6040
Mailing address
140 S BEACH ST, DAYTONA BEACH, FL 32114-4472
(386) 898-6040
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA31296
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA31296
PTA LICENSE
FL
Enumeration date
08/17/2021
Last updated
08/17/2021
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