Basic Information
| Provider Information | |||||||||
| NPI: | 1154381044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOSBY | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 176 N MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | VAN ALSTYNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754959700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034829741 | ||||||||
| FaxNumber: | 9034829742 | ||||||||
| Practice Location | |||||||||
| Address1: | 5323 HARRY HINES BLVD | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753907208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146450624 | ||||||||
| FaxNumber: | 2146450078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 08/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1157601 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 168934101 | 05 | TX | MEDICAID |