Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1255363040 |
---|---|
Provider Name | Ms. Janice Marie Moore |
First Address | Custer, SD 57730-7100 |
Second Address | Hot Springs, SD 57747-1480 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |