Provider Demographics
NPI:1033626791
Name:MOORE, BYRON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 WAKE FOREST BUSINESS PARK STE 110
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6578
Mailing Address - Country:US
Mailing Address - Phone:919-570-7080
Mailing Address - Fax:919-570-7081
Practice Address - Street 1:843 WAKE FOREST BUSINESS PARK STE 110
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-570-7080
Practice Address - Fax:919-570-7081
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18051208100000X
NJ40QA01762300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist