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General NPI Number Information
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NPI Number | 1366444267
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Entity Type | Individual
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Provider Name | JUSTIN L MOORE DPT
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 987 BROOKVILLE ST
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City | FAIRMOUNT CITY
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State | PA
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Zip | 16224-0046
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Country | US
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Telephone | 814-275-1000
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Fax | 814-275-1003
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Provider Business Mailing Address
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Address Line | PO BOX 46 987 BROOKVILLE STREET
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City | FAIRMOUNT CITY
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State | PA
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Zip | 16224-0046
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Country | US
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Telephone | 814-275-1000
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Fax | 814-275-1003
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | PT013701L
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License Number State | PA
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