Individual
MARY VIRIGINIA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 N KINGS HWY STE 3, WAKE VILLAGE, TX 75501-5787
(903) 794-0055
Mailing address
303 N CENTER ST, NEW BOSTON, TX 75570-2918
(903) 628-7700
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2164356
TX
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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