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NPI Code Detail

MEDICARE: MELZIE JONATHAN MOORE

MEDICARE: MELZIE JONATHAN MOORE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant29303FL

General Provider Information

NPI Number : 1164082418
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELZIE JONATHAN MOORE
Provider Business Mailing Address
First Line : 701 N WILDER RD
Second Line :
City : PLANT CITY
State : FL
Zip : 33566-7547
Country : US
Telephone Number : 813-752-3611
Fax Number :
Provider Business Practice Location Address
First Line : 701 N WILDER RD
Second Line :
City : PLANT CITY
State : FL
Zip : 33566-7547
Country : US
Telephone Number : 813-752-3611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2019
Last Update Date : 06/18/2019

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Directions to “ MELZIE JONATHAN MOORE ” Practice Location

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