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NPI Code Detail

MEDICARE: MR. WILLIAM HENRY MOORE PT

MEDICARE: MR. WILLIAM HENRY 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 Therapist19906MD

General Provider Information

NPI Number : 1396940094
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM HENRY MOORE PT
Provider Business Mailing Address
First Line : 4661 S LEISURE CT
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21043-6423
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1525 N ROLLING RD
Second Line :
City : CATONSVILLE
State : MD
Zip : 21228-1100
Country : US
Telephone Number : 410-402-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2007
Last Update Date : 02/01/2008

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