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NPI Code Detail

MEDICARE: MRS. LAURA SIMCHAK MOORE MPT

MEDICARE: MRS. LAURA SIMCHAK MOORE MPT
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
1225100000XPhysical Therapist5964AZ
22251P0200XPediatric Physical Therapist5964AZ

General Provider Information

NPI Number : 1255380853
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA SIMCHAK MOORE MPT
Provider Business Mailing Address
First Line : 1530 E ROCKWOOD DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85024-2958
Country : US
Telephone Number : 602-750-1448
Fax Number :
Provider Business Practice Location Address
First Line : 3401 N 67TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85033-4517
Country : US
Telephone Number : 623-691-4032
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2006
Last Update Date : 12/03/2009

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