Individual
MRS. KRISTY LEE MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1111 CRATER LAKE AVE, MEDFORD, OR 97504-6241
(541) 732-6619
Mailing address
1111 CRATER LAKE AVE, MEDFORD, OR 97504-6241
(541) 732-6619
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
07917
OR
Other
Enumeration date
08/08/2018
Last updated
08/08/2018
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