Shawn A Moore, MPT, CSCS
Individual provider Active NPI Physical Therapist · Marion, OH
NPI 1508946005 · NPPES record last updated Aug 19, 2024
Key facts
- NPI
- 1508946005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- P23080 (NC)
- Practice address
- 1069 Delaware Ave
Suite 102
Marion, OH 43302-6464 - Phone
- (740) 382-1734
- Fax
- (740) 387-6918
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240924003283 | NC | Practitioner - Physical Therapist in Private Practice | 4880764216 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P23080 | NC | MD | Physical Therapist |
| PT08805 | OH | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benchmark Physical Therapy of NC, LLC | Physical Therapist | Current |
Accepting new patients |
| Benchmark Physical Therapy of North Carolina LLC | Physical Therapist | Current |
Accepting new patients |
| Agilitas USA, Inc | Physical Therapist | Current |
Accepting new patients |
| Agilitas USA Inc | Physical Therapist | Current |
Accepting new patients |
| Physical Therapy and Hand Specialists, LLC | Physical Therapist | Current |
Accepting new patients |
| Drayer Physical Therapy of North Carolina LLC | Physical Therapist | Current |
Accepting new patients |
| Total Care Physical Therapy,LLC | Physical Therapist | Current |
Accepting new patients |
| Physical Therapy and Hand Specialist, LLC | Current |
Accepting new patients | |
| Advanced Health | Physical Therapist | Past | Accepting new patients |
Locations
1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568
207 E Meadow Rd
Ste 3
Eden, NC 27288
Phone (336) 627-3771
10020 Monroe Rd
Ste 160
Matthews, NC 28105
Phone (704) 841-0894
1901 NW Cary Pkwy
Ste 110
Morrisville, NC 27560
Phone (919) 678-1525
1520 Sunday Dr
Ste 105
Raleigh, NC 27607
Phone (919) 420-1682
5619 Carolina Beach Rd
Ste 120
Wilmington, NC 28412
Phone (910) 790-1976
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT08805 | OH | |
| Physical Therapist | 225100000X | P23080 | NC | Yes |
Addresses
Primary practice location
1069 Delaware Ave
Suite 102
Marion, OH 43302-6464
Mailing address
218 Kitdare Dr
Delaware, OH 43015-7077
Phone (419) 656-7084
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2429438 | Medicaid | OH |
Other providers in Marion, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.