Provider Demographics
NPI:1649883703
Name:MOORE, DAVID D II (MPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:D
Last Name:MOORE
Suffix:II
Gender:M
Credentials:MPT
Other - Prefix:
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Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:461 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4439
Practice Address - Country:US
Practice Address - Phone:641-423-6279
Practice Address - Fax:641-423-6707
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA01946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist