Jamie Moore, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA 26354 Issued in FL

Practice address

4565 US Highway 17 Ste 200
Fleming Island, FL 32003-4823

Phone

(904) 634-0640

NPI assigned

Jan 8, 2016

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1452211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1992161871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2836 CROSS CREEK DR",
            "city": "GREEN COVE SPRINGS",
            "state": "FL",
            "postal_code": "320436234",
            "telephone_number": "904-505-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4565 US HIGHWAY 17 STE 200",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320034823",
            "telephone_number": "904-634-0640"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2140 Kingsley Ave",
            "address_2": "Suite 5",
            "address_purpose": "LOCATION",
            "city": "Orange Park",
            "state": "FL",
            "postal_code": "320735180",
            "country_code": "US",
            "telephone_number": "904-272-2830",
            "fax_number": "904-272-8814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JAMIE",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-08",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA 26354",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Fleming Island, FL
• Providers in Fleming Island, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; 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.