Provider Demographics
NPI:1740870930
Name:MOORE, CHERYL ASHLIN (DPT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ASHLIN
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPT
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Mailing Address - Street 1:23521 PASEO DE VALENCIA
Mailing Address - Street 2:SUITE B7
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3140
Mailing Address - Country:US
Mailing Address - Phone:949-597-0007
Mailing Address - Fax:949-597-0040
Practice Address - Street 1:30100 TOWN CNTER DRIVE
Practice Address - Street 2:SUITE YZ
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2064
Practice Address - Country:US
Practice Address - Phone:949-276-5401
Practice Address - Fax:949-276-5403
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT299601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist