Individual
MICHAEL RYAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
628TH MEDICAL GROUP, 204 WEST HILL BLVD, CHARLESTON, SC 29404
(804) 571-5000
(804) 518-1314
Mailing address
2001 BUTTERFIELD RD STE 1600, DOWNERS GROVE, IL 60515-1211
(866) 370-8206
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2305206565
VA
225100000X
Physical Therapist
Primary
8765
SC
Other
Enumeration date
07/21/2010
Last updated
12/10/2025
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