Provider Demographics
NPI:1124130315
Name:MOORE, JOSEPH M (MPT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:MOORE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 ROUTE 70
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8704
Mailing Address - Country:US
Mailing Address - Phone:609-714-7733
Mailing Address - Fax:609-714-7750
Practice Address - Street 1:176 ROUTE 70
Practice Address - Street 2:SUITE 10
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8704
Practice Address - Country:US
Practice Address - Phone:609-714-7733
Practice Address - Fax:609-714-7750
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00689400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ047518RYMMedicare ID - Type Unspecified