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General NPI Number Information
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NPI Number | 1427062314
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Entity Type | Individual
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Provider Name | ARCHIE LEE MOORE JR. MPT
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 6958 GRANDWOOD WAY
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City | SAN JOSE
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State | CA
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Zip | 95120
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Country | US
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Telephone | 408-927-7811
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Fax | 408-268-5268
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Provider Business Mailing Address
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Address Line | 6958 GRANDWOOD WAY
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City | SAN JOSE
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State | CA
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Zip | 95120
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Country | US
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Telephone | 408-927-7811
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Fax | 408-268-5268
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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 | 23837
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License Number State | CA
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