Healthcare Provider Details

I. General information

NPI: 1316883747
Provider Name (Legal Business Name): EVAN MOORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 S LOUISE AVE
SIOUX FALLS SD
57108-6026
US

IV. Provider business mailing address

3414 E 28TH ST
SIOUX FALLS SD
57103-4404
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-3278
  • Fax:
Mailing address:
  • Phone: 605-280-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6192
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: