Provider Demographics
NPI:1700895190
Name:MOORE, WILLIAM JR (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JR
Last Name:MOORE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8391 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6048
Mailing Address - Country:US
Mailing Address - Phone:850-494-5403
Mailing Address - Fax:850-494-4910
Practice Address - Street 1:8391 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6048
Practice Address - Country:US
Practice Address - Phone:850-494-5403
Practice Address - Fax:850-494-6495
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4009174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT4009OtherPHYSICIAL THERAPIST LICEN
FLNPP000Medicare UPIN