Provider Demographics
NPI:1467163634
Name:MOORE, BRITTANY (PTA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:ELMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6301 HIGHWAY 45 STE B
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-8857
Mailing Address - Country:US
Mailing Address - Phone:479-763-1412
Mailing Address - Fax:479-763-1425
Practice Address - Street 1:6301 HIGHWAY 45 STE B
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-8857
Practice Address - Country:US
Practice Address - Phone:479-763-1412
Practice Address - Fax:479-763-1425
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant