Provider Demographics
NPI:1366509861
Name:MOORE, TERRENCE JOHN (PT)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:JOHN
Last Name:MOORE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 AMARAL CIR
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7134
Mailing Address - Country:US
Mailing Address - Phone:925-462-4976
Mailing Address - Fax:
Practice Address - Street 1:1111 E STANLEY BLVD
Practice Address - Street 2:STE D
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4115
Practice Address - Country:US
Practice Address - Phone:925-243-1385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 15165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist