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General NPI Number Information
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NPI Number | 1215985585
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Entity Type | Individual
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Provider Name | SEAN T. MOORE MPT
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 180 TICES LN
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-1337
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Country | US
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Telephone | 732-418-7033
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Fax | 732-418-7011
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Provider Business Mailing Address
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Address Line | 202 SAINT JAMES AVE
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City | UNION BEACH
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State | NJ
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Zip | 07735-2816
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Country | US
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Telephone | 732-418-7033
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Fax | 732-418-7011
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | QA01034900
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License Number State | NJ
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