Mary Viriginia Moore

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2164356 Issued in TX

Practice address

600 N Kings Hwy Ste 3
Wake Village, TX 75501-5787

Phone

(903) 794-0055

NPI assigned

Oct 17, 2024

Sex

Female

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mount Pleasant Physical Therapy PC

  • Physical Therapist
  • New Boston, TX
  • NPI 1366497570
  NPD

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

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1023839628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N CENTER ST",
            "city": "NEW BOSTON",
            "state": "TX",
            "postal_code": "755702918",
            "telephone_number": "903-628-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 N KINGS HWY STE 3",
            "city": "WAKE VILLAGE",
            "state": "TX",
            "postal_code": "755015787",
            "telephone_number": "903-794-0055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 N Center St",
            "address_purpose": "LOCATION",
            "city": "New Boston",
            "state": "TX",
            "postal_code": "755702918",
            "country_code": "US",
            "telephone_number": "903-628-7700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5416 Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755031661",
            "country_code": "US",
            "telephone_number": "903-794-0333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARY",
        "middle_name": "VIRIGINIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-17",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2164356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shauna McClain
• Lindsey M McFaul, FNP
• Karen M Meinzer, MS, CCC/SLP
• Sara Leanne Miers, N.P.
• Bapi Mirabeau, RNBSN
• Craig David Mueller, FNP
• National Seating & Mobility, Inc.
• Daniel Nejadi, PHARMD
• Oxygen Rich, LLC
• Rhonda Marie Phillips

• All providers in Wake Village, TX
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.