MEDICARE: BEAU 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	225100000X	Physical Therapist	10912	LA

General Provider Information

NPI Number	:	1730754433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEAU MOORE

Provider Business Mailing Address
First Line	:	321 VETERANS MEMORIAL BLVD STE 100
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70005-3060
Country	:	US
Telephone Number	:	504-834-9259
Fax Number	:	504-834-9281

Provider Business Practice Location Address
First Line	:	321 VETERANS MEMORIAL BLVD STE 100
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70005-3060
Country	:	US
Telephone Number	:	504-834-9259
Fax Number	:	504-834-9281

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

Provider Enumeration Date	:	05/25/2021
Last Update Date	:	05/25/2021

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Directions to “ BEAU MOORE ” Practice Location

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