Active NPI
Austin Moore, PT, DPT
- Physical Therapist
- Woodbury, MN
National Provider Identifier
1659928703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11612
- Practice address
- 2090 Woodwinds Dr
Woodbury, MN 55125-2522 - Phone
- (651) 968-5201
- NPI assigned
- Aug 23, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 | 11612 | MN | Primary |
Addresses
Primary practice location
2090 Woodwinds Dr
Woodbury, MN 55125-2522
Mailing address
4550 Minnetonka Blvd Apt 209
Saint Louis Park, MN 55416-5416
Phone (651) 795-1778
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566518400000",
"number": "1659928703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4550 MINNETONKA BLVD APT 209",
"city": "SAINT LOUIS PARK",
"state": "MN",
"postal_code": "554165416",
"telephone_number": "651-795-1778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2090 WOODWINDS DR",
"city": "WOODBURY",
"state": "MN",
"postal_code": "551252522",
"telephone_number": "651-968-5201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "AUSTIN",
"credential": "PT, DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-08-23",
"last_updated": "2019-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "11612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.