Healthcare Provider Details

I. General information

NPI: 1417868142
Provider Name (Legal Business Name): MAVIS GRACE MOREE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W ROOSEVELT BLVD
MONROE NC
28110-3435
US

IV. Provider business mailing address

600 HOSPITAL DR
MONROE NC
28112-6000
US

V. Phone/Fax

Practice location:
  • Phone: 980-993-3277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP24577
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: