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NPI Code Detail

MEDICARE: JAMES WILLIAM MOORE PT

MEDICARE:   JAMES WILLIAM MOORE  PT
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
1225100000XPhysical TherapistPT00003916WA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01853416OTHERWARR MEDICARE

Other Identifiers

General Provider Information

NPI Number : 1295718146
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES WILLIAM MOORE PT
Provider Business Mailing Address
First Line : 16083 SW UPPER BOONES FERRY RD STE 300
Second Line :
City : TIGARD
State : OR
Zip : 97224-7736
Country : US
Telephone Number : 800-219-8835
Fax Number : 503-639-9699
Provider Business Practice Location Address
First Line : 101 E HASTINGS RD STE J
Second Line :
City : SPOKANE
State : WA
Zip : 99218-4901
Country : US
Telephone Number : 509-466-4379
Fax Number : 509-466-4407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2005
Last Update Date : 07/21/2022

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