Healthcare Provider Details

I. General information

NPI: 1710921408
Provider Name (Legal Business Name): MOORE PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 BROOKVILLE STREET
FAIRMOUNT CITY PA
16224-0046
US

IV. Provider business mailing address

PO BOX 46 987 BROOKVILLE STREET
FAIRMOUNT CITY PA
16224-0046
US

V. Phone/Fax

Practice location:
  • Phone: 814-275-1000
  • Fax: 814-275-1003
Mailing address:
  • Phone: 814-275-1000
  • Fax: 814-275-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT013701L
License Number StatePA

VIII. Authorized Official

Name: JUSTIN LYNN MOORE
Title or Position: DPT/PRESIDENT
Credential: DPT
Phone: 814-275-1000