Individual
KRISTEN KOSOLA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
208 SMITH ST, LAGRANGE, GA 30240-2755
(706) 845-7002
(706) 845-0488
Mailing address
PO BOX 370, FORTSON, GA 31808-0370
(706) 494-3008
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
006298
GA
Other
Enumeration date
02/07/2007
Last updated
06/08/2020
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