MEDICARE: MRS. TRULY JOY MOORE PT

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
1	225100000X	Physical Therapist	7651	OH

General Provider Information

NPI Number	:	1174642623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRULY JOY MOORE PT

Provider Business Mailing Address
First Line	:	1606 OXFORD ST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-2350
Country	:	US
Telephone Number	:	419-529-0105
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 AVALON RD
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1403
Country	:	US
Telephone Number	:	740-397-3200
Fax Number	:	740-397-4326

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	04/17/2009

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