Individual
DONNA CARLISLE MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
1313 LAWRENCE ST, IRONDALE, AL 35210-1401
(205) 613-6570
Mailing address
1313 LAWRENCE ST, IRONDALE, AL 35210-1401
(205) 613-6570
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA585
AL
Other
Enumeration date
11/21/2012
Last updated
11/21/2012
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