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NPI Code Detail

MEDICARE: SHANDRA COLLEEN MOORE

MEDICARE: SHANDRA COLLEEN 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
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1952032005
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANDRA COLLEEN MOORE
Provider Business Mailing Address
First Line : 920 EDGECLIFF DR
Second Line :
City : BEDFORD
State : TX
Zip : 76022-7416
Country : US
Telephone Number : 817-773-4703
Fax Number :
Provider Business Practice Location Address
First Line : 2365 PATRIOT HTS
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80904-5122
Country : US
Telephone Number : 719-667-5360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2022
Last Update Date : 06/20/2022

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Directions to “ SHANDRA COLLEEN MOORE ” Practice Location

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