Individual
SARA AMALIA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MAT, ATC
Contact information
Practice address
300 PULTENEY ST, GENEVA, NY 14456-3304
(315) 781-3000
Mailing address
443 S MAIN ST APT 1, GENEVA, NY 14456-3156
(925) 519-3359
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000052450
BOARD OF CERTIFICATION
—
Enumeration date
09/30/2020
Last updated
09/21/2024
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