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General NPI Number Information
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NPI Number | 1588151740
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Entity Type | Individual
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Provider Name | CAROLYN JEAN MOORE DPT
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Gender | Female
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 100 BALDWIN BLVD
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City | FISHERSVILLE
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State | VA
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Zip | 22939-2375
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Country | US
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Telephone | 540-887-4073
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Fax |
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Provider Business Mailing Address
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Address Line | 300 PELHAM DR
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City | WAYNESBORO
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State | VA
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Zip | 22980-1511
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Country | US
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Telephone | 734-417-9162
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Fax |
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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 | 2305209352
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License Number State | VA
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