Provider Demographics
NPI:1588084941
Name:MOORE, ALAN DOUGLAS (PT, MPT, DPT)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:DOUGLAS
Last Name:MOORE
Suffix:
Gender:M
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 1:4557 LUTHER ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2231
Mailing Address - Country:US
Mailing Address - Phone:951-529-6062
Mailing Address - Fax:
Practice Address - Street 1:3400 CENTRAL AVE STE 145
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2161
Practice Address - Country:US
Practice Address - Phone:951-297-3399
Practice Address - Fax:951-297-3404
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist