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General NPI Number Information
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NPI Number | 1780678417
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Entity Type | Organization
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Legal Business Name | MOORMAN & ASSOCIATES PC
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 3515 FANNIN ST SUITE 101
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City | BEAUMONT
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State | TX
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Zip | 77701-3815
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Country | US
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Telephone | 409-835-0033
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Fax | 409-835-0213
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Provider Business Mailing Address
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Address Line | 3515 FANNIN ST SUITE 101
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City | BEAUMONT
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State | TX
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Zip | 77701-3815
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Country | US
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Telephone | 409-835-0033
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Fax | 409-835-0213
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DAVID MALLGRAVE
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Credential | LPT
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Telephone | 409-835-0033
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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 | 620030000
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License Number State | TX
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