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NPI Code Detail

MEDICARE: SOJA MOORE PT, DPT

MEDICARE: SOJA 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
1225100000XPhysical Therapist
2225100000XPhysical TherapistPT210002295DC
3390200000XStudent in an Organized Health Care Education/Training Program
4225100000XPhysical Therapist053261NY

General Provider Information

NPI Number : 1316665698
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOJA MOORE PT, DPT
Provider Business Mailing Address
First Line : 31 E 32ND ST FL 4
Second Line :
City : NEW YORK
State : NY
Zip : 10016-5595
Country : US
Telephone Number : 212-759-2282
Fax Number : 212-379-2123
Provider Business Practice Location Address
First Line : 458 5TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11215-4643
Country : US
Telephone Number : 646-847-1734
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2022
Last Update Date : 10/29/2024

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