MEDICARE: MS. JANA LYNN MOORE L.P.T.

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	1048296	TX

General Provider Information

NPI Number	:	1982736443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANA LYNN MOORE L.P.T.

Provider Business Mailing Address
First Line	:	1927 LOHMANS CROSSING RD
Second Line	:	SUITE 100
City	:	AUSTIN
State	:	TX
Zip	:	78734-5239
Country	:	US
Telephone Number	:	512-891-6788
Fax Number	:

Provider Business Practice Location Address
First Line	:	1927 LOHMANS CROSSING RD
Second Line	:	SUITE 100
City	:	AUSTIN
State	:	TX
Zip	:	78734-5239
Country	:	US
Telephone Number	:	512-261-0620
Fax Number	:

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

Provider Enumeration Date	:	03/11/2007
Last Update Date	:	07/08/2007

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