MEDICARE: MR. JOSEPH MOORE MSPT

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	2251X0800X	Orthopedic Physical Therapist	PT009031	GA

General Provider Information

NPI Number	:	1518189935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH MOORE MSPT

Provider Business Mailing Address
First Line	:	2109 N PATTERSON ST
Second Line	:	SUITE A
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2946
Country	:	US
Telephone Number	:	229-247-5225
Fax Number	:	229-241-8471

Provider Business Practice Location Address
First Line	:	2109 N PATTERSON ST
Second Line	:	SUITE A
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2946
Country	:	US
Telephone Number	:	229-247-5225
Fax Number	:	229-241-8471

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	04/20/2008

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Directions to “ MR. JOSEPH MOORE MSPT” Practice Location

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