Individual provider Active NPI

Rebecca Nicole Moore, PT, DPT

  • Physical Therapist
  • Hagerstown, MD
National Provider Identifier
1174294805
Registry record updated Aug 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
28671 Issued in MD
Practice address
13114 Pennsylvania Ave
Hagerstown, MD 21742-2741
Phone
(301) 800-7770
NPI assigned
Sep 22, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 28671 MD Primary

Addresses

Primary practice location

13114 Pennsylvania Ave
Hagerstown, MD 21742-2741

Mailing address

13114 Pennsylvania Ave
Hagerstown, MD 21742-3720

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211119000516 MD Practitioner - Physical Therapist in Private Practice 3274922802 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Group practices
Rehab 2 Perform LLCGroup PAC ID 6002199064, 92 clinicians
Premiere Spine and Sports Medicine LLCGroup PAC ID 6901170885, 4 clinicians

Practice addresses (Care Compare)

10312 Governor Lane Blvd
Unit 5008
Williamsport, MD 21795-4127
Phone (301) 798-4838

13114 Pennsylvania Ave
Hagerstown, MD 21742-3720
Phone (301) 800-7770

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28671MDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Premiere Spine and Sports Medicine LLC CurrentSince Sep 16, 2021 Accepting new patients
Premiere Spine and Sports Medicine LLC CurrentSince May 1, 2024 Accepting new patients

Locations

1165 Imperial Dr
Ste 100
Hagerstown, MD 21740
Phone (301) 800-7770

13114 Pennsylvania Ave
#A
Hagerstown, MD 21742
Phone (301) 800-7770

13114 Pennsylvania Ave
#B
Hagerstown, MD 21742
Phone (301) 800-7770

13114 Pennsylvania Ave
Hagerstown, MD 21742
Phone (240) 313-3310

1165 Imperial Dr
#103
Hagerstown, MD 21740

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IGCDDD
  • FHIR API: https://fhir4.healow.com/fhir/r4/IGCDDD/Endpoint/IGCDDD
  • FHIR API: https://api.platform.athenahealth.com/16159/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1632268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1174294805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13114 PENNSYLVANIA AVE",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217423720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13114 PENNSYLVANIA AVE",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217422741",
            "telephone_number": "301-800-7770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "REBECCA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-22",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "28671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.