Active NPI
Madison Moore
- Physical Therapist
- Saint Petersburg, FL
National Provider Identifier
1831920222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 42119
- Practice address
- 4020 Park St N Ste 101
Saint Petersburg, FL 33709-4030 - Phone
- (727) 388-4688
- NPI assigned
- Aug 8, 2024
- 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 Therapist | 225100000X | 42119 | FL | Primary |
Addresses
Primary practice location
4020 Park St N Ste 101
Saint Petersburg, FL 33709-4030
Mailing address
4020 Park St N Ste 101
Saint Petersburg, FL 33709-4030
Phone (727) 388-4688
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42119 | FL | MD | Physical Therapist |
Networks
- Optimum HealthCare HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723075200000",
"number": "1831920222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4020 PARK ST N STE 101",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337094030",
"telephone_number": "727-388-4688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4020 PARK ST N STE 101",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337094030",
"telephone_number": "727-388-4688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "MADISON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-08",
"last_updated": "2024-08-08",
"certification_date": "2024-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "42119",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.