Basic Information
| Provider Information | |||||||||
| NPI: | 1376955989 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | EMILY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 BUCKHANNON PIKE | ||||||||
| Address2: | |||||||||
| City: | NUTTER FORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263014307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046221600 | ||||||||
| FaxNumber: | 3046224747 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 BUCKHANNON PIKE | ||||||||
| Address2: | |||||||||
| City: | NUTTER FORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263014307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046221600 | ||||||||
| FaxNumber: | 3046224747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2014 | ||||||||
| LastUpdateDate: | 12/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT003307 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.