MEDICARE: CAMERON OLIN MOORE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT32598	FL

General Provider Information

NPI Number	:	1093239386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON OLIN MOORE DPT

Provider Business Mailing Address
First Line	:	8226 SANGUINELLI RD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34637-7528
Country	:	US
Telephone Number	:	620-440-1093
Fax Number	:

Provider Business Practice Location Address
First Line	:	3820 NORTHDALE BLVD STE 101A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1834
Country	:	US
Telephone Number	:	813-264-7734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	07/28/2017

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