Provider Demographics
NPI:1023820990
Name:MOORE, STEPHEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 COUNTY ROAD 428
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8217
Mailing Address - Country:US
Mailing Address - Phone:870-243-5479
Mailing Address - Fax:
Practice Address - Street 1:1809 E PARKER RD STE D
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-7854
Practice Address - Country:US
Practice Address - Phone:870-243-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist