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General NPI Number Information
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NPI Number | 1922046259
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Entity Type | Individual
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Provider Name | MICHELE A MOORE PT
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Gender | Female
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 3100 TRADITION CIR
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City | MT PLEASANT
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State | SC
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Zip | 29466-7200
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Country | US
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Telephone | 843-654-7945
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Fax |
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Provider Business Mailing Address
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Address Line | 9101 WESLEYAN RD STE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-3103
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Country | US
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Telephone | 800-603-6046
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Fax | 317-884-3388
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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 | 773
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License Number State | SC
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