MEDICARE: PERI MOORE

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	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578139879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERI MOORE

Provider Business Mailing Address
First Line	:	745 ORIENTA AVE STE 1011
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5675
Country	:	US
Telephone Number	:	877-823-4283
Fax Number	:	352-332-8589

Provider Business Practice Location Address
First Line	:	2730 ENTERPRISE RD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8320
Country	:	US
Telephone Number	:	877-823-4283
Fax Number	:	352-332-8589

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

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	05/28/2021

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Directions to “ PERI MOORE ” Practice Location

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