Healthcare Provider Details

I. General information

NPI: 1952216582
Provider Name (Legal Business Name): NATSUMI MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 HERITAGE TRL STE 301
NAPLES FL
34112-8716
US

IV. Provider business mailing address

5230 TUCKERMAN LN APT 216
NORTH BETHESDA MD
20852-3475
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-6848
  • Fax:
Mailing address:
  • Phone: 703-258-4801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306606190
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: