Healthcare Provider Details

I. General information

NPI: 1164495271
Provider Name (Legal Business Name): SHAUN MOORE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 FOULK RD STE 2D
WILMINGTON DE
19803-3733
US

IV. Provider business mailing address

12 PELHAM RD
WILMINGTON DE
19803-4133
US

V. Phone/Fax

Practice location:
  • Phone: 302-654-8142
  • Fax: 302-478-7544
Mailing address:
  • Phone: 484-459-1851
  • Fax: 302-654-8142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: