Individual
JESSE R MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC, LMT
Contact information
Practice address
8111 S EMERSON AVE, INDIANAPOLIS, IN 46237-8601
(317) 528-5000
Mailing address
8237 LENOX LN APT A, INDIANAPOLIS, IN 46268-4628
(317) 417-7597
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36003079A
IN
Other
Enumeration date
12/16/2018
Last updated
12/16/2018
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