Organization
MOORE PHYSICAL THERAPY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN LYNN MOORE DPT (DPT/PRESIDENT)
(814) 275-1000
Entity
Organization
Contact information
Practice address
987 BROOKVILLE STREET, FAIRMOUNT CITY, PA 16224-0046
(814) 275-1000
(814) 275-1003
Mailing address
PO BOX 46, 987 BROOKVILLE STREET, FAIRMOUNT CITY, PA 16224-0046
(814) 275-1000
(814) 275-1003
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT013701L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000147398
UNISON/THREE RIVERS
PA
01
—
0000001974231
ACCESS
PA
01
—
1562974
HIGHMARK/BLUE CROSS
PA
01
—
262202
COVENTRY HEALTH CARE
PA
Enumeration date
06/15/2006
Last updated
08/22/2020
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