Individual provider Active NPI

Kwame Marcus Moore, DPT

  • Physical Therapist
  • Jacksonville, AR
National Provider Identifier
1700448214
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4401 Issued in AR
Practice address
1 Woodland Dr
Jacksonville, AR 72076-2558
Phone
(501) 533-0259
NPI assigned
Jul 4, 2019
Last updated
Oct 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 4401 AR Primary

Addresses

Primary practice location

1 Woodland Dr
Jacksonville, AR 72076-2558

Mailing address

1 Woodland Dr
Jacksonville, AR 72076-2558
Phone (501) 533-0259

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

LicenseStateTypeSpecialty
4401ARMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Moore Solutions Inc Physical Therapist CurrentSince Nov 28, 2021 Accepting new patients
Moore Solutions, Inc. Physical Therapist CurrentSince Oct 10, 2021 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1562198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1700448214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WOODLAND DR",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720762558",
            "telephone_number": "501-533-0259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WOODLAND DR",
            "city": "JACKSONVILLE",
            "state": "AR",
            "postal_code": "720762558",
            "telephone_number": "501-533-0259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KWAME",
        "middle_name": "MARCUS",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-04",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "4401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; 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.