Bobby Moore DPT, PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

BOBBY MOORE DPT, PLLC

Doing business as

Sideout Sports Physical Therapy

Practice address

249 NW 71St Street
Oklahoma City, OK 73116

Phone

(580) 364-3312

Fax

(405) 592-5297

NPI assigned

Apr 25, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bobby Lee Moore Jr., PTNPI 1770246688

Title

Physical Therapist

Phone

(580) 364-3312

Specialties & licenses 1

Addresses

Other names 1

• Sideout Sports Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bobby Lee Moore Jr., DPT

  • Physical Therapist
  • Oklahoma City, OK
  • NPI 1770246688
  Medicare reassignment NPD Authorized official
• Cameron Eischen, PT, DPT, CSCS

  • Physical Therapist
  • Oklahoma City, OK
  • NPI 1871485904
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759968000000",
    "number": "1003504317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18221 CAMBORNE AVE",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730123221",
            "telephone_number": "580-364-3312",
            "fax_number": "405-592-5297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "249 NW 71ST STREET",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73116",
            "telephone_number": "580-364-3312",
            "fax_number": "405-592-5297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOBBY MOORE DPT, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-25",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "580-364-3312",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sideout Sports Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Board of Rengents of the Univ of Oklahoma - Ou Phys Breast Institute
• Jalisha Boatman
• McKinley Boatner, PA
• Sean McKinley Boatner Sr.
• Jay Saunders Bobb, DO
• Bobby R Jacobs MD PC
• Toni Bobek
• Delandria Bobo
• Mary L Bobo, LCSW
• Bobs Pharmacy

• Physical Therapy Clinic/Center in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Physical Therapy Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.