Andrew L. Moore, P.T.A.

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

6817 Issued in SC

Practice address

420-B McNulty Road P.O. Box 219
Blythewood, SC 29016-8926

Phone

(803) 728-0421

NPI assigned

Feb 20, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1740009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1003612003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420-B MCNULTY ROAD P.O. BOX 219",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290168926",
            "telephone_number": "803-728-0421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420-B MCNULTY ROAD P.O. BOX 219",
            "city": "BLYTHEWOOD",
            "state": "SC",
            "postal_code": "290168926",
            "telephone_number": "803-728-0421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ANDREW",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "credential": "P.T.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-20",
        "last_updated": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SC",
            "license": "6817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Blythewood, SC
• Providers in Blythewood, SC by specialty
• Physical Therapy Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.