MEDICARE: CHRISTINE MOORE

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1629776927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MOORE

Provider Business Mailing Address
First Line	:	4560 SE INTERNATIONAL WAY STE 100
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-4628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 E QUINCY AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-2309
Country	:	US
Telephone Number	:	831-917-7164
Fax Number	:

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

Provider Enumeration Date	:	02/16/2023
Last Update Date	:	02/16/2023

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Directions to “ CHRISTINE MOORE ” Practice Location

Language	Start Address	Practice Location

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