Provider Demographics
NPI:1548686512
Name:MOORE, MICHELLE RACHEL (DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RACHEL
Last Name:MOORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RACHEL
Other - Last Name:EVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:750 N ESTRELLA PKWY STE 50
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-9279
Mailing Address - Country:US
Mailing Address - Phone:623-882-2992
Mailing Address - Fax:623-925-4923
Practice Address - Street 1:750 N ESTRELLA PKWY STE 50
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9279
Practice Address - Country:US
Practice Address - Phone:623-882-2992
Practice Address - Fax:623-925-4923
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10217PT225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy