Provider Demographics
NPI:1588300321
Name:MOORE, PHILIP (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
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 1:782 RIVERFRONT PKWY APT 209
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-1622
Mailing Address - Country:US
Mailing Address - Phone:717-805-5515
Mailing Address - Fax:
Practice Address - Street 1:8021 E BRAINERD RD STE 106
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-0004
Practice Address - Country:US
Practice Address - Phone:423-435-9407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist