Individual
GRACE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3360 GATEWAY RD STE 100, BROOKFIELD, WI 53045-5115
(262) 923-7101
Mailing address
1304 ORIOLE DR, KAUKAUNA, WI 54130-2672
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4292-019
WI
Other
Enumeration date
01/15/2026
Last updated
01/15/2026
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