Audra Moore, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2037 Issued in WV

Practice address

200 Gaston Ave
Fairmont, WV 26554-2739

Phone

(203) 624-6554

Fax

(304) 624-5223

NPI assigned

Mar 4, 2008

Last updated

Mar 4, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Audra Gallucci Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Marion County Board of Education

  • Local Education Agency (LEA)
  • Fairmont, WV
  • NPI 1245409127
  NPD (past)
• Marion County Board of Education

  • Local Education Agency (LEA)
  • Fairmont, WV
  • NPI 1528244183
  NPD (past)

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

{
    "created_epoch": "1204588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204588800000",
    "number": "1689844789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 GASTON AVE",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265542739",
            "telephone_number": "203-624-6554",
            "fax_number": "304-624-5223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GASTON AVE",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265542739",
            "telephone_number": "203-624-6554",
            "fax_number": "304-624-5223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "AUDRA",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-04",
        "last_updated": "2008-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "2037",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7302178000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDRA",
            "last_name": "GALLUCCI",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Monongalia County General Hospital Company (Mon Health Medical Center)
• Monongalia County General Hospital Company (Mon Health Medical Center)
• Morgan Renae Montgomery
• Stephen L Moon, OD
• Tracy Ann Mooney
• Brenda Lee Moore
• Courtney Dawn Moore
• Halle Moore
• Hannah Sue Moore
• Heather Moore

• Physical Therapist in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Physical Therapist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; 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.