Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 5088 | SC |
NPI | 1013084144 |
---|---|
Provider Name | Dr. Sara Romansky Moore |
First Address | Greenwood, SC 29648-1115 |
Second Address | Greenwood, SC 29646-2641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 16/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TH 1754 | (05) | SC |