Provider Demographics
NPI:1376955989
Name:MOORE, EMILY (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 BUCKHANNON PIKE
Mailing Address - Street 2:
Mailing Address - City:NUTTER FORT
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4307
Mailing Address - Country:US
Mailing Address - Phone:304-622-1600
Mailing Address - Fax:304-622-4747
Practice Address - Street 1:435 BUCKHANNON PIKE
Practice Address - Street 2:
Practice Address - City:NUTTER FORT
Practice Address - State:WV
Practice Address - Zip Code:26301-4307
Practice Address - Country:US
Practice Address - Phone:304-622-1600
Practice Address - Fax:304-622-4747
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT003307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist