Healthcare Provider Details

I. General information

NPI: 1699689018
Provider Name (Legal Business Name): DAVID WAYNE MOORE LMBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 S NEW HOPE RD STE 2
GASTONIA NC
28056-8597
US

IV. Provider business mailing address

3670 S NEW HOPE RD STE 2
GASTONIA NC
28056-8597
US

V. Phone/Fax

Practice location:
  • Phone: 704-838-5505
  • Fax:
Mailing address:
  • Phone: 704-838-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18762
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: