MEDICARE: SALLY A MOORES PT, DPT, OCS

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	16361	MA

General Provider Information

NPI Number	:	1609927128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY A MOORES PT, DPT, OCS

Provider Business Mailing Address
First Line	:	15 MYSTIC RD
Second Line	:
City	:	MARBLEHEAD
State	:	MA
Zip	:	01945-1015
Country	:	US
Telephone Number	:	206-947-6242
Fax Number	:

Provider Business Practice Location Address
First Line	:	564 LORING AVE
Second Line	:	SUITE 2
City	:	SALEM
State	:	MA
Zip	:	01970-4276
Country	:	US
Telephone Number	:	781-797-7210
Fax Number	:

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	09/13/2016

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