Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

John Moore

Individual provider Physical Therapist · NPI 1265849483

John Moore is a Physical Therapist in Private Practice in Lake Wylie, South Carolina. Qualified in 2014, 12 years ago. Practices with Ivyrehab North Carolina LLC, a 154-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Kentucky, North Carolina, Ohio and South Carolina.

Years since qualifying
12
Licensed in
KY, NC, OH, SC
In the registry since
2014
Specialties on file
4
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Practice location Address checks out

439 Channel Rd Ste 102
Lake Wylie, SC 29710
Phone: (803) 746-7800
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 11003 Montgomery Rd, Cincinnati, OH 45249-2306 — (513) 469-1444

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 9041 (SC)
Physical Therapist Taxonomy 225100000X · Licence 006430 (KY)
Physical Therapist Taxonomy 225100000X · Licence 014731 (OH)
Orthopedic Physical Therapist Taxonomy 2251X0800X · Licence P16648 (NC)

Record details

NPI number1265849483
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 21, 2014
Last updated in NPPESJanuary 4, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Ivyrehab North Carolina Llc — 154 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Lake Wylie