Provider Demographics
NPI:1740758481
Name:MOORE, DEBORAH KAY (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:KAY
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12613 TAYLORSVILLE RD STE 118
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-5496
Mailing Address - Country:US
Mailing Address - Phone:502-267-1480
Mailing Address - Fax:
Practice Address - Street 1:12613 TAYLORSVILLE RD STE 118
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-5496
Practice Address - Country:US
Practice Address - Phone:502-267-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist