Active NPI
Donald C. Moore, PT
- Physical Therapist
- Venice, FL
National Provider Identifier
1689727075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT0002104
- Practice address
- 4120 Woodmere Park Blvd
Suite 5
Venice, FL 34293-5373 - Phone
- (941) 408-0670
- NPI assigned
- Jan 19, 2007
- Last updated
- Jul 8, 2007
- 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 | PT0002104 | FL | Primary |
Addresses
Primary practice location
4120 Woodmere Park Blvd
Suite 5
Venice, FL 34293-5373
Mailing address
433 Pinewood Lake Dr
Venice, FL 34285-5680
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 |
|---|---|---|---|
| PT0002104 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689727075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "433 PINEWOOD LAKE DR",
"city": "VENICE",
"state": "FL",
"postal_code": "342855680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 WOODMERE PARK BLVD",
"address_2": "SUITE 5",
"city": "VENICE",
"state": "FL",
"postal_code": "342935373",
"telephone_number": "941-408-0670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "DONALD",
"middle_name": "C.",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT0002104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Venice, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.