Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT60560556 | WA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT60560556 | WA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT60560556 | WA |
NPI | 1083143846 |
---|---|
Provider Name | Carolyn Christine Weiser Moore |
First Address | Tacoma, WA 98405-4234 |
Second Address | Auburn, WA 98002-5406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2017 |
Last Update Date | 06/06/2017 |