Individual
KELLY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
22502 SAMBAR LOOP, CHUGIAK, AK 99567-5377
(907) 726-4663
(844) 605-1820
Mailing address
PO BOX 672075, CHUGIAK, AK 99567-2075
(907) 726-4663
(844) 605-1820
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
011150
NY
225100000X
Physical Therapist
Primary
800
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PT4330
—
AK
Enumeration date
03/23/2007
Last updated
04/27/2025
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