Samantha Jordan Moore, PT, DPT
Physical Therapist in Davis, CA. Individual provider (NPI-1).
NPI number1003606963
StatusActive
Last updated in NPPESMay 12, 2025
Details
- NPI
- 1003606963
- Entity type
- Individual (NPI-1)
- Name
- Samantha Jordan Moore
- Credential
- PT, DPT
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 12, 2025
- Certification date
- May 12, 2025
- Last updated
- May 12, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICAL THERAPIST IN PRIVATE PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | 308028 | CA | Yes |
Practice location
1460 Drew Ave Ste 200Davis, CA 95618-4856
Phone 530-304-5169 · Fax 530-753-9021
Mailing address
1460 Drew Ave Ste 200Davis, CA 95618-4856
Phone 530-304-5169
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 55 Physical Therapist providers in Davis · All 1,968 providers in Davis
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