MEDICARE: CHRISTOPHER J MOORE P.T.

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	225100000X	Physical Therapist	002242	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598701997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER J MOORE P.T.

Provider Business Mailing Address
First Line	:	719 FAIRMONT AVE
Second Line	:	SUITE 102
City	:	FAIRMONT
State	:	WV
Zip	:	26554-5118
Country	:	US
Telephone Number	:	304-363-8543
Fax Number	:	304-363-0173

Provider Business Practice Location Address
First Line	:	802 E MAIN ST
Second Line	:
City	:	MANNINGTON
State	:	WV
Zip	:	26582-1215
Country	:	US
Telephone Number	:	304-986-9007
Fax Number	:	304-986-9080

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	11/28/2007

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