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General NPI Number Information
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NPI Number | 1386382497
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Entity Type | Individual
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Provider Name | HAYDEN LAWRENCE MOORE PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 03/22/2023
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Provider Practice Location Address
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Address Line | 615 LILLY RD NE STE 240
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City | OLYMPIA
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State | WA
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Zip | 98506-5117
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Country | US
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Telephone | 360-413-3850
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Fax | 360-359-4726
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Provider Business Mailing Address
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Address Line | 615 LILLY RD NE STE 240
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City | OLYMPIA
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State | WA
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Zip | 98506-5117
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Country | US
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Telephone | 360-413-3850
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Fax | 360-359-4726
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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 | 8157
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2022029713
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP018896T
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License Number State | WA
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