Provider Demographics
NPI:1275669095
Name:MOORE, CAROLE L (PT)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:L
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 1:31 OLD ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1714
Mailing Address - Country:US
Mailing Address - Phone:203-740-0020
Mailing Address - Fax:203-775-0238
Practice Address - Street 1:6 SHAWS CV
Practice Address - Street 2:STE 101
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4969
Practice Address - Country:US
Practice Address - Phone:860-447-3009
Practice Address - Fax:860-447-1320
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist