Individual
MICHAEL M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2021 MAHANEY AVE, TAHLEQUAH, OK 74464-5794
(918) 458-5115
Mailing address
1519 NORTHPARK DR, TAHLEQUAH, OK 74464-6240
(405) 802-2086
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6041
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200994650A
—
OK
Enumeration date
05/25/2021
Last updated
09/21/2021
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