Provider Demographics
NPI:1528633419
Name:MOORE, MARINA KAY (DPT)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:KAY
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 KITE PL
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-9438
Mailing Address - Country:US
Mailing Address - Phone:919-903-0503
Mailing Address - Fax:
Practice Address - Street 1:100 COMMUNITY DR STE B
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-9505
Practice Address - Country:US
Practice Address - Phone:540-932-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000030358074OtherDRIVER'S LICENSE