Provider Demographics
NPI:1134286172
Name:MOORE, FRANCIS PETER (RPT)
Entity Type:Individual
Prefix:MR
First Name:FRANCIS
Middle Name:PETER
Last Name:MOORE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 BEAR HILL RD
Mailing Address - Street 2:POB 202
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-3216
Mailing Address - Country:US
Mailing Address - Phone:207-564-2131
Mailing Address - Fax:207-564-2131
Practice Address - Street 1:1164 BEAR HILL RD
Practice Address - Street 2:POB 202
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-3216
Practice Address - Country:US
Practice Address - Phone:207-564-2131
Practice Address - Fax:207-564-2131
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME00234225100000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1207370001OtherDME PROVIDER NUMBER
MEMM1082Medicare ID - Type Unspecified