Provider Demographics
NPI:1003974874
Name:MOORE, ANNA MEANS (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MEANS
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-1906
Mailing Address - Country:US
Mailing Address - Phone:318-841-0696
Mailing Address - Fax:318-841-0776
Practice Address - Street 1:2950 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-1906
Practice Address - Country:US
Practice Address - Phone:318-841-0696
Practice Address - Fax:318-841-0776
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07110R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3B260DK23Medicare PIN