Mallory Moore, PT,DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305210720 Issued in VA

Practice address

100 Crofton PL
Palmyra, VA 22963-3300

Phone

(434) 589-9588

Fax

(434) 589-4096

NPI assigned

Sep 8, 2014

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)

Enrolled

Practice roles

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.

• Southeastern Physical Therapy, Inc

  • Physical Therapist
  • Palmyra, VA
  • NPI 1740407527
  NPD (past)

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

{
    "created_epoch": "1410134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515974400000",
    "number": "1396146403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4668 PEMBROKE BLVD STE 115",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234556423",
            "telephone_number": "757-648-8562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CROFTON PL",
            "city": "PALMYRA",
            "state": "VA",
            "postal_code": "229633300",
            "telephone_number": "434-589-9588",
            "fax_number": "434-589-4096"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11120 North Fwy",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770371029",
            "country_code": "US",
            "telephone_number": "281-875-1800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MALLORY",
        "name_prefix": "Dr.",
        "credential": "PT,DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-08",
        "last_updated": "2018-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305210720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael W McMurray, PT
• Brendan Freeman McNulty, DPT
• Phyllis Blattstain Montellese, MD
• Monticello Mobility LLC
• Cynthia Louise Moore, RD, CDCES, NBC-HWC,
• Susan J. Moore, M.D.
• James E Moyer, L.P.C.
• Elizabeth Anne Murphey, LCSW
• Carl Brandon Myers, OD
• Amy Elizabeth Nash, LCSW

• All providers in Palmyra, VA
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2018; 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.