Healthcare Provider Details

I. General information

NPI: 1225014962
Provider Name (Legal Business Name): MELISSA ANN MOORE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MISSY ANN MOORE

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date: 05/25/2006
Reactivation Date: 12/03/2008

III. Provider practice location address

231 GRANITE RUN DR
LANCASTER PA
17601-6823
US

IV. Provider business mailing address

4013 PARKSIDE CT
MOUNT JOY PA
17552-9253
US

V. Phone/Fax

Practice location:
  • Phone: 717-560-4200
  • Fax: 717-560-6380
Mailing address:
  • Phone: 717-560-4200
  • Fax: 717-560-6380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-007638-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT007638L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: