Provider Demographics
NPI:1699145375
Name:MOORE, JEFFREY C (DPT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:MOORE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2572 W STATE ROAD 426 STE 1080
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8300
Mailing Address - Country:US
Mailing Address - Phone:407-796-5265
Mailing Address - Fax:407-796-5260
Practice Address - Street 1:2572 W STATE ROAD 426 STE 1080
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8300
Practice Address - Country:US
Practice Address - Phone:407-796-5265
Practice Address - Fax:407-796-5260
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT306362251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic