Provider Demographics
NPI:1477868990
Name:MOORE, ASHLEY NICOLE (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:ASHLEY
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
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 1:2100 SILVA LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3600
Mailing Address - Country:US
Mailing Address - Phone:660-263-6223
Mailing Address - Fax:660-263-6224
Practice Address - Street 1:2100 SILVA LN STE B
Practice Address - Street 2:PEAK SPORT AND SPINE
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3600
Practice Address - Country:US
Practice Address - Phone:660-263-6223
Practice Address - Fax:660-263-6224
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-016733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist