Individual
MR. GARY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
200 SW 14TH ST, NEWTON, KS 67114-4701
(316) 283-4770
(316) 283-5199
Mailing address
200 SW 14TH ST, NEWTON, KS 67114-4701
(316) 283-4770
(316) 283-5199
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-01561
KS
Other
Enumeration date
01/18/2011
Last updated
01/18/2011
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