Provider Demographics
NPI:1821237843
Name:MOORE, DANIELA (PT)
Entity type:Individual
Prefix:MISS
First Name:DANIELA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 NW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8793
Mailing Address - Country:US
Mailing Address - Phone:347-200-8063
Mailing Address - Fax:561-258-2730
Practice Address - Street 1:614 NW 25TH AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8793
Practice Address - Country:US
Practice Address - Phone:347-200-8063
Practice Address - Fax:561-258-2730
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist