Provider Demographics
NPI:1174642623
Name:MOORE, TRULY JOY (PT)
Entity Type:Individual
Prefix:MRS
First Name:TRULY
Middle Name:JOY
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2350
Mailing Address - Country:US
Mailing Address - Phone:419-529-0105
Mailing Address - Fax:
Practice Address - Street 1:13 AVALON RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1403
Practice Address - Country:US
Practice Address - Phone:740-397-3200
Practice Address - Fax:740-397-4326
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist