Individual
TRENT MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1227 E 32ND ST, STE 7, JOPLIN, MO 64804-2880
(417) 624-7400
(417) 624-7403
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(816) 226-4011
(816) 524-6115
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2014019063
MO
225100000X
Physical Therapist
PT 3851
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA4370081
MEDICARE PTAN
MO
Enumeration date
05/20/2014
Last updated
07/29/2014
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