Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306604873 | VA |
NPI | 1013676071 |
---|---|
Provider Name | Floyd Alexander Moore III |
First Address | North Chesterfield, VA 23237-1984 |
Second Address | North Chesterfield, VA 23237-1984 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2021 |
Last Update Date | 16/12/2021 |