Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT4305 | ME |
NPI | 1003293259 |
---|---|
Provider Name | Julie-Anne Moore |
First Address | Bangor, ME 04401-5213 |
Second Address | Brewer, ME 04412-1628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2015 |
Last Update Date | 27/04/2015 |