Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 18051 | NC |
N | 225100000X | Physical Therapist | 40QA01762300 | NJ |
NPI | 1033626791 |
---|---|
Provider Name | Byron Moore |
First Address | Wake Forest, NC 27587-6578 |
Second Address | Wake Forest, NC 27587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2018 |
Last Update Date | 13/07/2018 |