Individual
MICHAEL C MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
305 LOCUST AVE, OAKDALE, NY 11769-1652
(631) 218-5900
Mailing address
38 SEMINOLE DR, COMMACK, NY 11725-4625
(917) 716-5572
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
010896-1
NY
Other
Enumeration date
04/16/2019
Last updated
04/16/2019
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