Provider Demographics
NPI:1124276936
Name:MOORE, NATHANIEL ELLIOTT (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:ELLIOTT
Last Name:MOORE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SCUFFLETOWN RD STE B
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-7296
Mailing Address - Country:US
Mailing Address - Phone:864-254-5899
Mailing Address - Fax:864-254-5898
Practice Address - Street 1:216 SCUFFLETOWN RD STE B
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-7296
Practice Address - Country:US
Practice Address - Phone:864-254-5899
Practice Address - Fax:864-254-5898
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT 61762251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist