Individual
DUSTIN C MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
404 NW HALL OF FAME DR, LAKE CITY, FL 32055-4833
(386) 755-3164
(386) 755-3165
Mailing address
404 NW HALL OF FAME DR, LAKE CITY, FL 32055-4833
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
21966
FL
Other
Enumeration date
10/13/2011
Last updated
10/13/2011
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