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General NPI Number Information
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NPI Number | 1134492093
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Entity Type | Individual
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Provider Name | CASEY BLYTHE MOORE MS, ATC, SCAT
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Gender | Female
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 3300 PALMETTO HWY
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City | GREENVILLE
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State | SC
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Zip | 29613-0001
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Country | US
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Telephone | 828-260-1308
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Fax |
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Provider Business Mailing Address
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Address Line | 7863 CHAMPION WAY UNIT A
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City | NORTH CHARLESTON
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State | SC
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Zip | 29418-2210
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Country | US
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Telephone | 828-260-1308
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 1258
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License Number State | SC
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