Moose Physical Therapy, PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

MOOSE PHYSICAL THERAPY, PLLC

Practice address

2000 W Pioneer Pkwy Ste 22
Peoria, IL 61615-5805

Phone

(309) 670-0853

Fax

(309) 279-5211

NPI assigned

Sep 18, 2020

Organization subpart

No

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

Authorized official

Name

Jeremy Calame, PT, DPTNPI 1164735601

Title

Managing Member

Phone

(309) 670-0853

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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.

• Jeremy Daniel Calame, PT, DPT

  • Physical Therapist
  • Peoria, IL
  • NPI 1164735601
  Medicare reassignment Care Compare group NPD Authorized official
• Jonathan Hamm, PT

  • Physical Therapist
  • Washington, IL
  • NPI 1992932289
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635638400000",
    "number": "1053927640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 W PIONEER PKWY STE 22",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616155805",
            "telephone_number": "309-670-0853",
            "fax_number": "309-279-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 W PIONEER PKWY STE 22",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616155805",
            "telephone_number": "309-670-0853",
            "fax_number": "309-279-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOOSE PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-18",
        "last_updated": "2021-10-31",
        "certification_date": "2021-10-31",
        "status": "A",
        "authorized_official_last_name": "CALAME",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "309-670-0853",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aimee Moore, PTA
• Elizabeth D Moore, PA
• Evan Moore
• Jamie Lyn Moore, LMT
• Trenadie Moore
• Paul Stuart Moots, MD
• Sergio Eli Morales
• Kavya Moravineni, MD
• Jack Edward Mordeson, MD
• Matthew J. Mordhorst, PH.D.

• Physical Therapist in Peoria, IL
• Providers in Peoria, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2021; 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.