Individual
MRS. PHYLLIS DIANE MOORE I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AAS
Contact information
Practice address
2710 TROTWOOD AVE, COLUMBIA, TN 38401-4903
(391) 388-7182
Mailing address
3617 CRAIG BRIDGE RD, WILLIAMSPORT, TN 38487-2160
(931) 583-2757
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
246
TN
Other
Enumeration date
10/03/2006
Last updated
07/08/2007
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