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General NPI Number Information
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NPI Number | 1700530557
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Entity Type | Individual
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Provider Name | MASON LEE MOORE PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 9881 BROKEN LAND PKWY STE 103
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City | COLUMBIA
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State | MD
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Zip | 21046-3013
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Country | US
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Telephone | 828-231-0624
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Fax |
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Provider Business Mailing Address
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Address Line | 252 FOREST HILL DR
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City | ASHEVILLE
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State | NC
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Zip | 28803-2406
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Country | US
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Telephone | 828-231-0624
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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 | P21039
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License Number State | NC
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