Individual
MISS LISA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1010 S 144TH ST, OMAHA, NE 68154-2801
(402) 715-1515
Mailing address
1010 S 144TH ST, OMAHA, NE 68154-2801
(402) 715-1515
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
329
NE
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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