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Individual

JENNIFER LYNN MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.T.

Contact information

Practice address
15000 MINNETONKA BLVD, MINNETONKA, MN 55345-1506
(952) 935-4037
Mailing address
3225 HUMBOLDT AVE S, MINNEAPOLIS, MN 55408-3329
(612) 750-1870

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2868
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1024610
PREFFERED 1 GROUP NUMBER
MN
01
25557MO
BLUE CROSS INDIVIDUAL ID
MN
Enumeration date
01/24/2007
Last updated
07/08/2007
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