Active NPI
Bradley Kent Moore, PT
- Physical Therapist
- Bossier City, LA
National Provider Identifier
1427480573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 08553
- Practice address
- 2000 Blake Blvd
Bossier City, LA 71111-2232 - Phone
- (318) 383-6751
- Fax
- (318) 963-8797
- NPI assigned
- Jul 31, 2013
- Last updated
- Aug 27, 2019
- Sex
- Male
- 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 | 08553 | LA | Primary |
Addresses
Primary practice location
2000 Blake Blvd
Bossier City, LA 71111-2232
Mailing address
PO Box 51266
Lafayette, LA 70505-1266
Phone (337) 233-1307
Other practice location 1
1100 C M Fagan Dr
Suite 103
Hammond, LA 70403-5963
Phone (985) 542-6664
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 |
|---|---|---|---|
| 08553 | LA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566864000000",
"number": "1427480573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 51266",
"city": "LAFAYETTE",
"state": "LA",
"postal_code": "705051266",
"telephone_number": "337-233-1307",
"fax_number": "337-233-5764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 BLAKE BLVD",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "711112232",
"telephone_number": "318-383-6751",
"fax_number": "318-963-8797"
}
],
"practiceLocations": [
{
"address_1": "1100 C M Fagan Dr",
"address_2": "Suite 103",
"address_purpose": "LOCATION",
"city": "Hammond",
"state": "LA",
"postal_code": "704035963",
"country_code": "US",
"telephone_number": "985-542-6664",
"fax_number": "985-542-6428",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOORE",
"first_name": "BRADLEY",
"middle_name": "KENT",
"name_prefix": "Dr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-07-31",
"last_updated": "2019-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "08553",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bossier City, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.