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Individual

MR. KEVIN DWAYNE MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
500 W AQUA AVE, COEUR D ALENE, ID 83815-7764
(208) 762-1122
Mailing address
500 W AQUA AVE, COEUR D ALENE, ID 83815-7764
(208) 762-1122

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA344
ID

Other

Enumeration date
05/27/2008
Last updated
05/27/2008
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