Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306604626 | VA |
NPI | 1003326968 |
---|---|
Provider Name | Brittany Rheyonna Moore |
First Address | Glen Allen, VA 23058-2152 |
Second Address | Fredericksburg, VA 22407-6100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2017 |
Last Update Date | 05/10/2017 |