Individual
MS. LISA KATHLEEN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
9116 FOOTHILL BLVD STE 102, RANCHO CUCAMONGA, CA 91730-6564
(909) 941-7177
(909) 941-1717
Mailing address
11206 ROSARITA DR, LOMA LINDA, CA 92354-3210
(909) 435-1753
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT2345
CA
Other
Enumeration date
07/18/2006
Last updated
07/08/2007
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