Provider Demographics
NPI:1255700340
Name:MOORE, HEATHER (PTA)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:BADIN
Mailing Address - State:NC
Mailing Address - Zip Code:28009
Mailing Address - Country:US
Mailing Address - Phone:828-291-1351
Mailing Address - Fax:
Practice Address - Street 1:620 HEATHWOOD DR
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-8604
Practice Address - Country:US
Practice Address - Phone:704-983-2687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2206225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant