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NPI Code Detail

MEDICARE: BRITTANY MOORE PTA

MEDICARE: BRITTANY MOORE PTA
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 Assistant

General Provider Information

NPI Number : 1467163634
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITTANY MOORE PTA
Provider Business Mailing Address
First Line : 6301 HIGHWAY 45 STE B
Second Line :
City : FORT SMITH
State : AR
Zip : 72916-8857
Country : US
Telephone Number : 479-763-1412
Fax Number : 479-763-1425
Provider Business Practice Location Address
First Line : 6301 HIGHWAY 45 STE B
Second Line :
City : FORT SMITH
State : AR
Zip : 72916-8857
Country : US
Telephone Number : 479-763-1412
Fax Number : 479-763-1425
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2022
Last Update Date : 12/08/2022

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