Provider Demographics
NPI:1003504317
Name:BOBBY MOORE DPT, PLLC
Entity Type:Organization
Organization Name:BOBBY MOORE DPT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:580-364-3312
Mailing Address - Street 1:2938 NW 12TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-5333
Mailing Address - Country:US
Mailing Address - Phone:580-364-3312
Mailing Address - Fax:405-592-5297
Practice Address - Street 1:2938 NW 12TH ST APT 4
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-5333
Practice Address - Country:US
Practice Address - Phone:580-364-3312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy