Healthcare Provider Details

I. General information

NPI: 1649107566
Provider Name (Legal Business Name): JEANNIE EVA MOORE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29775 HAUN RD
MENIFEE CA
92586-6540
US

IV. Provider business mailing address

27107 LOST PALM ST
MENIFEE CA
92585-3256
US

V. Phone/Fax

Practice location:
  • Phone: 951-672-1851
  • Fax:
Mailing address:
  • Phone: 951-816-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT291249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: