Doctor Name: | JESSE MOORE |
NPI Number: | 1043555410 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPT, MBA |
License Number: | 070018656 |
Business Practice Address: | 3008 Huntsville Dr Glen Carbon, IL - 620343046 |
Business Phone Number: | 3176916262 |
Business Fax Number: | |
Mailing Address: | 3008 Huntsville Dr, GLEN CARBON |
State: | IL |
Postal Code: | 620343046 |
Phone Number: | 3176916262 |
Fax Number: | |
NPI Enumeration Date: | 12/11/2012 |
NPI Last Update Date: | 12/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 070018656 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |