Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 7106 | TN |
NPI | 1003084047 |
---|---|
Provider Name | Jason Curtis Moore |
First Address | Jefferson City, TN 37760-3200 |
Second Address | Jefferson City, TN 37760-3200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 04/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3650168 | MEDICARE PTAN (01) | TN |