Individual
BENJAMIN R MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
555 EAST BROADWAY, SUITE 100, JACKSON, WY 83001
(307) 739-7491
Mailing address
8259 WICKER AVE, SAINT JOHN, IN 46373-8878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1189
WY
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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