Provider Demographics
NPI:1982324406
Name:MOORE, ELIZABETH BAILEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BAILEY
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23731 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-5103
Mailing Address - Country:US
Mailing Address - Phone:713-315-7584
Mailing Address - Fax:
Practice Address - Street 1:8120 LAKEVIEW PKWY STE 400
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4595
Practice Address - Country:US
Practice Address - Phone:972-412-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1365575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist