Healthcare Provider Details

I. General information

NPI: 1629747902
Provider Name (Legal Business Name): LEEANNE-ROSE MOORER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEEANNE-ROSE BAGAOISAN DPT

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 HIGHWAY 78 E
JASPER AL
35501-3433
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 334-380-4930
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH10939
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058339T
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058713T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: