Provider Demographics
NPI:1164495271
Name:MOORE, SHAUN (PT)
Entity type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-4133
Mailing Address - Country:US
Mailing Address - Phone:484-459-1851
Mailing Address - Fax:302-654-8142
Practice Address - Street 1:701 FOULK RD STE 2D
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3733
Practice Address - Country:US
Practice Address - Phone:302-654-8142
Practice Address - Fax:302-478-7544
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist