Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | 027917-1 | NY |
Y | 2251P0200X | Physical Therapist - Pediatrics | PT24176 | FL |
NPI | 1124276571 |
---|---|
Provider Name | Dr. Selegne Altagracia Moore |
First Address | Weston, FL 33331-3560 |
Second Address | Sunrise, FL 33351-8023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2008 |
Last Update Date | 27/08/2008 |