Healthcare Provider Details

I. General information

NPI: 1477881886
Provider Name (Legal Business Name): RAYMOND LIONEL MOORE III P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W COLD SPRING LN
BALTIMORE MD
21210-2831
US

IV. Provider business mailing address

200 W COLD SPRING LN
BALTIMORE MD
21210-2831
US

V. Phone/Fax

Practice location:
  • Phone: 410-662-7977
  • Fax: 410-662-4544
Mailing address:
  • Phone: 443-465-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number23138
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23138
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: