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General NPI Number Information
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NPI Number | 1003612003
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Entity Type | Individual
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Provider Name | ANDREW L. MOORE P.T.A.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 420-B MCNULTY ROAD P.O. BOX 219
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-8926
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Country | US
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Telephone | 803-728-0421
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Fax |
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Provider Business Mailing Address
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Address Line | 420-B MCNULTY ROAD P.O. BOX 219
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-8926
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Country | US
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Telephone | 803-728-0421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 6817
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License Number State | SC
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