Individual
DONNA S MOOSE I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
7639 SIFFORD RD, STANLEY, NC 28164-7715
(704) 827-1309
Mailing address
7639 SIFFORD RD, STANLEY, NC 28164-7715
(704) 827-1309
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
947
NC
Other
Enumeration date
05/10/2007
Last updated
07/08/2007
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