Provider Demographics
NPI:1164481552
Name:MOORE, THEODORE CRAIG (PT)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:CRAIG
Last Name:MOORE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 KIMO WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-9675
Mailing Address - Country:US
Mailing Address - Phone:530-878-7076
Mailing Address - Fax:
Practice Address - Street 1:250 ELM AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4226
Practice Address - Country:US
Practice Address - Phone:530-889-2411
Practice Address - Fax:530-889-2451
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT66802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic