Joyce L Moore, ATC/PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA3774 Issued in CA

Practice address

11392 Pleasant Valley Rd
Penn Valley, CA 95946-9001

Phone

(530) 432-9660

NPI assigned

Oct 29, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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 and National Provider Directory roles.

• New Edge Physical Therapy Inc

  dba Wildwood Physical Therapy Inc

  • Physical Therapist
  • Penn Valley, CA
  • NPI 1477196111
  NPD (past)
• Wildwood Physical Therapy Inc

  • Physical Therapy Clinic/Center
  • Penn Valley, CA
  • NPI 1952300782
  NPD (past)

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

{
    "created_epoch": "1509235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509235200000",
    "number": "1871005967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13996 HIGHLAND DR",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959458719",
            "telephone_number": "530-205-8870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11392 PLEASANT VALLEY RD",
            "city": "PENN VALLEY",
            "state": "CA",
            "postal_code": "959469001",
            "telephone_number": "530-432-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JOYCE",
        "middle_name": "L",
        "credential": "ATC/PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-29",
        "last_updated": "2017-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "PTA3774",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CA",
            "license": "000080967",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald Wayne Magnuson, DDS
• Edward L Meeker, PH.D
• Misty Merrifield
• Robert Edward Millington, D.D.S.
• Ursula M Monroe, L. AC
• Brian Moreau
• Wendy Sue Nelsen
• New Edge Physical Therapy Inc (Wildwood Physical Therapy Inc)
• Penn Valley Fire Protection District
• Penn Valley Seventh-Day Adventist Church (Helping Hands Caregiver Resource)

• Physical Therapy Assistant in Penn Valley, CA
• Providers in Penn Valley, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2017; 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.