Healthcare Provider Details

I. General information

NPI: 1083072755
Provider Name (Legal Business Name): ADAM MOORE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10765 LOIRE AVE
SAN DIEGO CA
92131-1537
US

IV. Provider business mailing address

10765 LOIRE AVE
SAN DIEGO CA
92131-1537
US

V. Phone/Fax

Practice location:
  • Phone: 858-535-1075
  • Fax: 858-535-1863
Mailing address:
  • Phone: 858-535-1075
  • Fax: 858-535-1863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: