Provider Demographics
NPI:1245485325
Name:MOORE THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:MOORE THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:484-459-1851
Mailing Address - Street 1:3317 TUNISON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3225
Mailing Address - Country:US
Mailing Address - Phone:484-459-1851
Mailing Address - Fax:302-478-7544
Practice Address - Street 1:1806 N VAN BUREN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-3851
Practice Address - Country:US
Practice Address - Phone:484-459-1851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2003104444261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy