Healthcare Provider Details

I. General information

NPI: 1538203914
Provider Name (Legal Business Name): DANIEL STEVEN MOORE MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 DENOW RD SUITE U
PENNINGTON NJ
08534-5246
US

IV. Provider business mailing address

800 DENOW RD
PENNINGTON NJ
08534-5246
US

V. Phone/Fax

Practice location:
  • Phone: 609-737-8130
  • Fax:
Mailing address:
  • Phone: 609-737-8130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00875000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: