Individual
GINA DIANA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
511 N BROAD ST, PHILADELPHIA, PA 19123-3230
(215) 923-6031
(215) 923-8269
Mailing address
4812 N 5TH ST, PHILADELPHIA, PA 19120-4125
(215) 324-6082
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT009919E
PA
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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