Active NPI
Mysti Moore, PT
- Physical Therapist
- Lackland AFB, TX
National Provider Identifier
1154309482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1141091
- Practice address
- 2200 Bergquist Dr
Attention Credentials (CMC)
Lackland a F B, TX 78236-9908 - Phone
- (210) 292-2095
- NPI assigned
- Jan 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 | 1141091 | TX | Primary |
Addresses
Primary practice location
2200 Bergquist Dr
Attention Credentials (CMC)
Lackland a F B, TX 78236-9908
Mailing address
1750 Barking Wolf
San Antonio, TX 78245
Phone (210) 521-3798
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1141091 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physical Therapy Providers, Inc. | Physical Therapist | Past | Accepting new patients |
| Professional Therapy Services | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapy Clinic/Center
- San Antonio, TX
- NPI 1629197140
Physical Therapist
-
- Physical Therapist
- San Antonio, TX
- NPI 1124034343
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154309482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1750 BARKING WOLF",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78245",
"telephone_number": "210-521-3798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 BERGQUIST DR",
"address_2": "ATTENTION CREDENTIALS (CMC)",
"city": "LACKLAND A F B",
"state": "TX",
"postal_code": "782369908",
"telephone_number": "210-292-2095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MYSTI",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1141091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lackland AFB, TX
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.