Individual
CASEY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
509 N ADELAIDE ST, NORMAL, IL 61761-2422
(309) 451-0393
Mailing address
25168 N 2200 EAST RD, LEXINGTON, IL 61753-7517
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.005502
IL
Other
Enumeration date
08/04/2014
Last updated
08/04/2014
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