Active NPI
Whitney Moore
- Physical Therapy Assistant
- South Bend, IN
National Provider Identifier
1679833438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06004421A
- Practice address
- 2012 Ironwood Circle, Suite 230
Circle Centre Building,
South Bend, IN 46635 - Phone
- (574) 387-4049
- NPI assigned
- May 25, 2012
- Last updated
- May 25, 2012
- Sex
- Female
- 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 Therapy Assistant | 225200000X | 06004421A | IN | Primary |
Addresses
Primary practice location
2012 Ironwood Circle, Suite 230
Circle Centre Building,
South Bend, IN 46635
Mailing address
2012 Ironwood Circle, Suite 230
Circle Centre Building,
South Bend, IN 46635
Phone (574) 387-4049
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06004421A | IN | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children's Therapy Innovations Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba CTI Aging and Rehabilitative Services
- Intellectual Disabilities Intermediate Care Facility
- South Bend, IN
- NPI 1407166192
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337904000000",
"number": "1679833438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2012 IRONWOOD CIRCLE, SUITE 230",
"address_2": "CIRCLE CENTRE BUILDING,",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "46635",
"telephone_number": "574-387-4049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2012 IRONWOOD CIRCLE, SUITE 230",
"address_2": "CIRCLE CENTRE BUILDING,",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "46635",
"telephone_number": "574-387-4049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "WHITNEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-05-25",
"last_updated": "2012-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06004421A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.