Healthcare Provider Details

I. General information

NPI: 1306077904
Provider Name (Legal Business Name): KATHERINE ROSMAN MOORE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 SPRINGHILL AVE
MOBILE AL
36607-2303
US

IV. Provider business mailing address

5900 MCDONALD RD
THEODORE AL
36582-4932
US

V. Phone/Fax

Practice location:
  • Phone: 251-639-0015
  • Fax:
Mailing address:
  • Phone: 251-423-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTH5621
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: