Provider Demographics
NPI:1538183710
Name:MOORE, HARRY LEE (PT)
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9401
Mailing Address - Country:US
Mailing Address - Phone:919-734-1311
Mailing Address - Fax:919-734-8816
Practice Address - Street 1:2503 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9401
Practice Address - Country:US
Practice Address - Phone:919-734-1311
Practice Address - Fax:919-734-8816
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7212028Medicaid
NC07802OtherBCBS
NC0356070001Medicare NSC
NC250067BMedicare ID - Type Unspecified