Provider Demographics
NPI:1407601792
Name:MOORE, ZACHARY (PT,DPT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 KALISPELL WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-2080
Mailing Address - Country:US
Mailing Address - Phone:309-798-1900
Mailing Address - Fax:
Practice Address - Street 1:4442 FRONTAGE RD NW UNIT 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2956
Practice Address - Country:US
Practice Address - Phone:423-458-6298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist