Healthcare Provider Details

I. General information

NPI: 1083807838
Provider Name (Legal Business Name): ELIZABETH STEWART MOORMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODWIN CREST DR SUITE 300
HOMEWOOD AL
35209-3701
US

IV. Provider business mailing address

PO BOX 19848
HOMEWOOD AL
35219-0848
US

V. Phone/Fax

Practice location:
  • Phone: 205-290-4550
  • Fax: 205-290-4560
Mailing address:
  • Phone: 205-290-4550
  • Fax: 205-290-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH2605
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: