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NPI Code Detail

MEDICARE: GEOFFREY PAUL MOORE PTA

MEDICARE: GEOFFREY PAUL 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 AssistantA704MN

General Provider Information

NPI Number : 1518549849
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEOFFREY PAUL MOORE PTA
Provider Business Mailing Address
First Line : 3050 CENTRE POINTE DR STE 200
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-1179
Country : US
Telephone Number : 651-631-4242
Fax Number :
Provider Business Practice Location Address
First Line : 3050 CENTRE POINTE DR STE 200
Second Line :
City : ROSEVILLE
State : MN
Zip : 55113-1179
Country : US
Telephone Number : 651-631-4242
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2021
Last Update Date : 04/26/2021

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Directions to “ GEOFFREY PAUL MOORE PTA” Practice Location

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