Provider Demographics
NPI:1841309440
Name:MOORE, REBECCA NORTHERN (PT, DPT, MDT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:NORTHERN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT, DPT, MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:210 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2176
Practice Address - Country:US
Practice Address - Phone:615-446-7623
Practice Address - Fax:615-446-7624
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT00000068862251X0800X
TN6886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPT0000006886OtherTN LICENSE