Provider Demographics
NPI:1790029437
Name:MOORE, DAVID M JR (DPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:MOORE
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 E PARHAM RD
Mailing Address - Street 2:MOB II SUITE 120
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4373
Mailing Address - Country:US
Mailing Address - Phone:804-545-4952
Mailing Address - Fax:804-545-4953
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:MOB II SUITE 120
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-545-4952
Practice Address - Fax:804-545-4953
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052050812251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports