Provider Demographics
NPI:1720798291
Name:MOORE, MELANIE ALEXANDRA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ALEXANDRA
Last Name:MOORE
Suffix:
Gender:F
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 1:16249 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4300
Mailing Address - Country:US
Mailing Address - Phone:305-405-0400
Mailing Address - Fax:
Practice Address - Street 1:11870 W SR-84
Practice Address - Street 2:#C3
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325
Practice Address - Country:US
Practice Address - Phone:954-474-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist