Provider Demographics
NPI:1689727075
Name:MOORE, DONALD C (PT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:C
Last Name:MOORE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 PINEWOOD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4120 WOODMERE PARK BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5373
Practice Address - Country:US
Practice Address - Phone:941-408-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0002104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist