Individual
MR. KRAIG MOULTRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.A.
Contact information
Practice address
11623 ARBOR ST, OMAHA, NE 68144-2981
(402) 334-1919
Mailing address
14 MARSHALL ST, APT. 10R, IRVINGTON, NJ 07111-3656
(862) 754-0275
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00258900
NJ
Other
Enumeration date
04/09/2009
Last updated
04/09/2009
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