Provider Demographics
NPI:1467893297
Name:MOORE, JOSHUA (PT,DPT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
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 1:205 W WACKER DR
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1216
Mailing Address - Country:US
Mailing Address - Phone:312-640-0329
Mailing Address - Fax:
Practice Address - Street 1:34572 N US HIGHWAY 45
Practice Address - Street 2:SPACE A
Practice Address - City:THIRD LAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-4037
Practice Address - Country:US
Practice Address - Phone:847-548-3695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist