MEDICARE: BREEANNA MOORE DPT

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	16585	TN

General Provider Information

NPI Number	:	1902782857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREEANNA MOORE DPT

Provider Business Mailing Address
First Line	:	270 G E MOORE RD
Second Line	:
City	:	WARTBURG
State	:	TN
Zip	:	37887-3008
Country	:	US
Telephone Number	:	423-577-5156
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 LETORY RD
Second Line	:
City	:	WARTBURG
State	:	TN
Zip	:	37887-3224
Country	:	US
Telephone Number	:	423-346-3220
Fax Number	:

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

Provider Enumeration Date	:	08/14/2025
Last Update Date	:	04/15/2026

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Directions to “ BREEANNA MOORE DPT” Practice Location

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