Individual
MR. KYLE PATRICK MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT, CSCS
Contact information
Practice address
40 COAL ST, WILKES BARRE, PA 18702-5236
(570) 270-6432
Mailing address
13 CORNELL RD, HUNLOCK CREEK, PA 18621-4000
(610) 223-3755
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT005261
PA
Other
Enumeration date
08/29/2013
Last updated
08/01/2014
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