Provider Demographics
NPI:1588772669
Name:MOORE, JAMES G (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:MOORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17210 128TH TRL N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-5217
Mailing Address - Country:US
Mailing Address - Phone:561-575-2853
Mailing Address - Fax:561-748-5442
Practice Address - Street 1:2532 W INDIANTOWN RD STE 2
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3935
Practice Address - Country:US
Practice Address - Phone:561-748-5430
Practice Address - Fax:561-748-5442
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL881315900Medicaid