Individual
MICHAEL BRYAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
445 MAPLE ST, DUBLIN, VA 24084-2918
(540) 616-8844
Mailing address
PO BOX 6957, RADFORD, VA 24142-6957
(540) 831-6218
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000607
VA
Other
Enumeration date
06/05/2019
Last updated
06/05/2019
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