Provider Demographics
NPI:1952417537
Name:MOORE, ADAM M (MPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:M
Last Name:MOORE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
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Mailing Address - Street 1:199 BROOKMOORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705
Mailing Address - Country:US
Mailing Address - Phone:662-327-6705
Mailing Address - Fax:662-327-6760
Practice Address - Street 1:276 NISSAN PARKWAY
Practice Address - Street 2:SUITE 400, BLDG. F
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-7006
Practice Address - Country:US
Practice Address - Phone:601-859-3776
Practice Address - Fax:601-859-3778
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSPT4075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist