MEDICARE: MR. SAMUEL L MOORE PT, DPT

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	3139	NV

General Provider Information

NPI Number	:	1225418999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMUEL L MOORE PT, DPT

Provider Business Mailing Address
First Line	:	250 COUNTRY CLUB PKWY
Second Line	:
City	:	SPRING CREEK
State	:	NV
Zip	:	89815-5830
Country	:	US
Telephone Number	:	775-777-1276
Fax Number	:	775-777-7022

Provider Business Practice Location Address
First Line	:	2072 IDAHO ST
Second Line	:
City	:	ELKO
State	:	NV
Zip	:	89801-2627
Country	:	US
Telephone Number	:	775-777-1276
Fax Number	:

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

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	10/07/2024

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