Individual
MS. AMY ELIZABETH MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
555 HOSPITAL LN, SUSANVILLE, CA 96130-4918
(530) 251-8108
(530) 251-8394
Mailing address
710-360 LAKE AVE, SUSANVILLE, CA 96130
(530) 251-8225
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801
—
CA
Enumeration date
05/07/2007
Last updated
01/07/2011
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