Individual
LACIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
6011 UNIVERSITY BLVD, SUITE 120, ELLICOTT CITY, MD 21043-6074
(410) 203-0391
(410) 203-2707
Mailing address
6011 UNIVERSITY BLVD, SUITE 120, ELLICOTT CITY, MD 21043-6104
(410) 203-0391
(410) 203-2707
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A3664
MD
Other
Enumeration date
12/09/2011
Last updated
07/16/2012
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