Provider Demographics
NPI:1710921408
Name:MOORE PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:MOORE PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:814-275-1000
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:987 BROOKVILLE STREET
Mailing Address - City:FAIRMOUNT CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16224-0046
Mailing Address - Country:US
Mailing Address - Phone:814-275-1000
Mailing Address - Fax:814-275-1003
Practice Address - Street 1:987 BROOKVILLE STREET
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT CITY
Practice Address - State:PA
Practice Address - Zip Code:16224-0046
Practice Address - Country:US
Practice Address - Phone:814-275-1000
Practice Address - Fax:814-275-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013701L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000147398OtherUNISON/THREE RIVERS
PA0000001974231OtherACCESS
PA262202OtherCOVENTRY HEALTH CARE
PA1562974OtherHIGHMARK/BLUE CROSS
PA262202OtherCOVENTRY HEALTH CARE
PA0000001974231OtherACCESS