Individual
JESSICA MOULTRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1195 WELLSVILLE RD, MEMPHIS, TN 38117-5941
(901) 692-8139
Mailing address
1195 WELLSVILLE RD, MEMPHIS, TN 38117
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA0000003986
TN
Other
Enumeration date
12/09/2013
Last updated
12/09/2013
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