Provider Demographics
NPI:1538807409
Name:MOORE, JENEFER (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:DR
First Name:JENEFER
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12744 LAKESIDE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-5274
Mailing Address - Country:US
Mailing Address - Phone:713-820-5937
Mailing Address - Fax:
Practice Address - Street 1:828 SHELDON RD
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-3512
Practice Address - Country:US
Practice Address - Phone:281-452-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist