Provider Demographics
NPI:1265786800
Name:MOORE, PHILLIP J (DPT)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:J
Last Name:MOORE
Suffix:
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 1:3125 INDEPENDENCE DR
Mailing Address - Street 2:STE 300B
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4159
Mailing Address - Country:US
Mailing Address - Phone:205-879-7501
Mailing Address - Fax:205-879-0675
Practice Address - Street 1:3125 INDEPENDENCE DR
Practice Address - Street 2:STE 300B
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-879-7501
Practice Address - Fax:205-879-0675
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALPTH6621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist