Individual
JUSTIN L MOORE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
987 BROOKVILLE ST, FAIRMOUNT CITY, PA 16224-0046
(814) 275-1000
(814) 275-1003
Mailing address
PO BOX 46, 987 BROOKVILLE STREET, FAIRMOUNT CITY, PA 16224-0046
(814) 275-1000
(814) 275-1003
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT013701L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MO1543448
BLUE CROSS INDEMNITY
PA
Enumeration date
08/11/2005
Last updated
07/08/2007
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