Provider Demographics
NPI:1275693806
Name:MOORE, ANTHONY V (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:V
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 1:5701 PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2254
Mailing Address - Country:US
Mailing Address - Phone:412-422-5100
Mailing Address - Fax:
Practice Address - Street 1:5701 PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2254
Practice Address - Country:US
Practice Address - Phone:412-422-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6040BMedicare ID - Type UnspecifiedMCR B ID