Provider Demographics
NPI:1518189935
Name:MOORE, JOSEPH (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 N PATTERSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2946
Mailing Address - Country:US
Mailing Address - Phone:229-247-5225
Mailing Address - Fax:229-241-8471
Practice Address - Street 1:2109 N PATTERSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2946
Practice Address - Country:US
Practice Address - Phone:229-247-5225
Practice Address - Fax:229-241-8471
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0090312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$OtherTRICARE