Provider Demographics
NPI:1063661684
Name:MOORE, JEFF (DPT)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W KAGY BLVD
Mailing Address - Street 2:STE. 101A
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5881
Mailing Address - Country:US
Mailing Address - Phone:406-556-0562
Mailing Address - Fax:406-556-0965
Practice Address - Street 1:1125 W KAGY BLVD
Practice Address - Street 2:STE. 101A
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5881
Practice Address - Country:US
Practice Address - Phone:406-556-0562
Practice Address - Fax:406-556-0965
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2173PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist