Provider Demographics
NPI:1972610400
Name:MOORE, CARL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1042
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE INSTITUTE
Mailing Address - State:AL
Mailing Address - Zip Code:36087
Mailing Address - Country:US
Mailing Address - Phone:334-727-0550
Mailing Address - Fax:334-725-0374
Practice Address - Street 1:2400 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083
Practice Address - Country:US
Practice Address - Phone:334-727-0550
Practice Address - Fax:334-725-3074
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist