Provider Demographics
NPI:1316315831
Name:MOORE, SYDNEY ROSSER (DPT)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:ROSSER
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 TATES CREEK CENTRE DR STE 144
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3068
Mailing Address - Country:US
Mailing Address - Phone:859-271-2887
Mailing Address - Fax:
Practice Address - Street 1:4101 TATES CREEK CENTRE DR STE 144
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3068
Practice Address - Country:US
Practice Address - Phone:859-271-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TXCP004608T225100000X
KY008275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist