Provider Demographics
NPI:1578879482
Name:MOORE, BETH K (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:K
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42445 HIGHWAY 195 EAST
Mailing Address - Street 2:VILLAGE EAST SHOPPING CENTER
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565
Mailing Address - Country:US
Mailing Address - Phone:205-486-8811
Mailing Address - Fax:205-486-8812
Practice Address - Street 1:42445 HIGHWAY 195 EAST
Practice Address - Street 2:VILLAGE EAST SHOPPING CENTER
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565
Practice Address - Country:US
Practice Address - Phone:205-486-8811
Practice Address - Fax:205-486-8812
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH5265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I654390Medicare Oscar/Certification