=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457564379
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEORA MOORE PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2855 CARLSBAD BLVD
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92008-2902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-435-2330
-----------------------------------------------------
Fax | 760-435-2393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3037 VIA ESTRADA
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92009-4550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-476-1925
-----------------------------------------------------
Fax | 888-574-3888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 24771
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------