Individual
MATTHEW MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 LASSO DR, WARNER ROBINS, GA 31088-6648
(478) 542-4918
Mailing address
4 STONE LN APT 5341, MALDEN, MA 02148-1579
(919) 889-9367
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3774
MA
Other
Enumeration date
02/13/2017
Last updated
06/04/2024
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