Healthcare Provider Details

I. General information

NPI: 1386575272
Provider Name (Legal Business Name): EMMA MARIE MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 LA JOYA ST
ESPANOLA NM
87532-2511
US

IV. Provider business mailing address

98 STATE ROAD 369
ESPANOLA NM
87532-9846
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-6550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: