Healthcare Provider Details

I. General information

NPI: 1649925124
Provider Name (Legal Business Name): TAYLOR A. MOORE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAYLOR BERGIN

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 VIRGINIA BEACH BLVD STE 101
VIRGINIA BEACH VA
23462-5631
US

IV. Provider business mailing address

5604 VIRGINIA BEACH BLVD STE 101
VIRGINIA BEACH VA
23462-5631
US

V. Phone/Fax

Practice location:
  • Phone: 757-455-5000
  • Fax:
Mailing address:
  • Phone: 757-455-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305217625
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT40438
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: