Provider Demographics
NPI:1619444197
Name:MOORE, ZACHARY ELLIOT
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ELLIOT
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 ALA WAI BLVD APT 903
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-5017
Mailing Address - Country:US
Mailing Address - Phone:808-769-7009
Mailing Address - Fax:
Practice Address - Street 1:2230 LILIHA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1646
Practice Address - Country:US
Practice Address - Phone:808-547-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-5863225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant