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

Mr. Kevin Dwayne Moore, PTA

Individual provider Physical Therapy Assistant · NPI 1124286109

Mr. Kevin Dwayne Moore, PTA is a Physical Therapy Assistant in Coeur D Alene, Idaho. Licensed in Idaho. Registered with an NPI since 2008.

Licensed in
ID
In the registry since
2008
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

See every abbreviation used in this directory →

Practice location Address checks out

500 W Aqua Ave
Coeur D Alene, ID 83815-7764
Phone: (208) 762-1122
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence PTA344 (ID)

Record details

NPI number1124286109
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorNo
NPI enumeratedMay 27, 2008
Last updated in NPPESMay 27, 2008
Mailing address500 W Aqua Ave, Coeur D Alene, ID 83815-7764

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