Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 007094 | KY |
N | 2251G0304X | Physical Therapist - Geriatrics | 1212496 | TX |
N | 2251N0400X | Physical Therapist - Neurology | 1212495 | TX |
N | 2251P0200X | Physical Therapist - Pediatrics | 1212495 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1212495 | TX |
NPI | 1134496854 |
---|---|
Provider Name | Dr. Judith Marie Moore |
First Address | Louisville, KY 40229-2182 |
Second Address | Nicholasville, KY 40356-6046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2011 |
Last Update Date | 15/06/2021 |