Healthcare Provider Details

I. General information

NPI: 1265710800
Provider Name (Legal Business Name): LINDSEY MARIE MOORE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY MARIE WARING PTA

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 MCINGVALE RD STE J
HERNANDO MS
38632-8696
US

IV. Provider business mailing address

2670 MCINGVALE RD STE J
HERNANDO MS
38632-8696
US

V. Phone/Fax

Practice location:
  • Phone: 662-548-2710
  • Fax: 662-548-2711
Mailing address:
  • Phone: 662-548-2710
  • Fax: 662-548-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4590
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7068
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: