Shelby Lauren Moore, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2014042706 Issued in MO

Practice address

334 E Mount Vernon Blvd
Mount Vernon, MO 65712-2024

Phone

(417) 423-7410

Fax

(417) 423-7411

NPI assigned

Dec 17, 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)

Not enrolled

State licenses

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

{
    "created_epoch": "1418774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1518365915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511",
            "telephone_number": "423-238-7217",
            "fax_number": "423-238-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "334 E MOUNT VERNON BLVD",
            "city": "MOUNT VERNON",
            "state": "MO",
            "postal_code": "657122024",
            "telephone_number": "417-423-7410",
            "fax_number": "417-423-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "SHELBY",
        "middle_name": "LAUREN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-17",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2014042706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mid - America Hearing Center, Inc
• Andrew Minardi
• Missouri Baptist Childrens Home
• Missouri Rehabilitation Center
• Missouri Veterans Commission (Missouri Veterans Home)
• Motherworks, LLC
• Mount Vernon Eyecare Associates, LLC
• Mt Vernon Place Care Center, Inc.
• Sandra Nkechi Muoghalu, DDS
• Linda Myers, MD

• Physical Therapy Assistant in Mount Vernon, MO
• Providers in Mount Vernon, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; 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.