Active NPI
Polly Eleanor Moore, P.T.
- Physical Therapist
- Durham, NC
National Provider Identifier
1144282823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1211
- Practice address
- 508 Fulton St
Durham, NC 27705-3875 - Phone
- (919) 286-0411
- NPI assigned
- Apr 6, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1211 | NC | Primary |
Addresses
Primary practice location
508 Fulton St
Durham, NC 27705-3875
Mailing address
PO Box 71623
Durham, NC 27722-1623
Phone (919) 479-8632
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1211 | Other | NC | P.T. LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1211 | NC | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144282823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 71623",
"city": "DURHAM",
"state": "NC",
"postal_code": "277221623",
"telephone_number": "919-479-8632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "508 FULTON ST",
"city": "DURHAM",
"state": "NC",
"postal_code": "277053875",
"telephone_number": "919-286-0411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "POLLY",
"middle_name": "ELEANOR",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "1211",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "P.T. LICENSE",
"identifier": "1211",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.