Individual
LOU ANN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
10019 WICKER PARK PL, PALMETTO, FL 34221-1109
(928) 201-4055
Mailing address
10019 WICKER PARK PL, PALMETTO, FL 34221-1109
(928) 201-4055
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT18899
FL
261QP2000X
Physical Therapy Clinic/Center
Primary
PT18899
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
888827200
—
FL
Enumeration date
09/27/2006
Last updated
03/23/2024
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