Provider Demographics
NPI:1194422790
Name:MOORE, KHIDA L (PT, MPT, DPT)
Entity type:Individual
Prefix:
First Name:KHIDA
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT, MPT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 S NORTH POINT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-3307
Mailing Address - Country:US
Mailing Address - Phone:410-282-0100
Mailing Address - Fax:410-505-1786
Practice Address - Street 1:1046 S NORTH POINT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-3307
Practice Address - Country:US
Practice Address - Phone:410-282-0100
Practice Address - Fax:410-505-1786
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist