Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTH3125 | AL |
NPI | 1003037383 |
---|---|
Provider Name | Krista Rene Moorer |
First Address | Monroeville, AL 36460-5111 |
Second Address | Monroeville, AL 36460-3044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51522936 | BCBS OF AL (01) | AL |