Troy Lance Moore, MPT, ATC

Key facts

NPI

1932201357

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

11-03659 (KS)

Practice address

300 N Park Ave
Ellinwood, KS 67526-1452

Phone

(620) 564-2548

Fax

(620) 564-2079

NPI assigned

Sep 5, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 3

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.

• Central Kansas Orthopedic Group, LLC Durable Medical Equipment & Medical Supplies · Great Bend, KS · NPI 1144599598
  NPD
• Achieve Rehab, LLC Hand Occupational Therapist · Great Bend, KS · NPI 1942399167
  NPD (past) PHYSICAL THERAPIST
• Wheatland Rehabilitation LLC Occupational Therapist · Great Bend, KS · NPI 1083656920
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 21, 2025.

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1932201357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 N PARK AVE",
            "city": "ELLINWOOD",
            "state": "KS",
            "postal_code": "675261452",
            "telephone_number": "620-564-2548",
            "fax_number": "620-564-2079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 N PARK AVE",
            "city": "ELLINWOOD",
            "state": "KS",
            "postal_code": "675261452",
            "telephone_number": "620-564-2548",
            "fax_number": "620-564-2079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "TROY",
        "middle_name": "LANCE",
        "name_prefix": "Mr.",
        "credential": "MPT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "T-00797",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-03659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200400390A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Ellinwood, KS · Physical Therapist in Kansas