Individual
DR. JEFFREY DAVID MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
700 US HWY 24 S, BUENA VISTA, CO 81211
(719) 297-9009
(719) 284-7163
Mailing address
PO BOX 5005, BUENA VISTA, CO 81211-5005
(719) 297-9009
(719) 284-7163
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTL0011913
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12433208
CAQH
CO
Enumeration date
09/28/2012
Last updated
02/22/2019
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