Individual
DANE ELLIS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1189 BEALL AVE, WOOSTER, OH 44691-2363
(608) 548-4335
Mailing address
1905 PORTAGE RD APT 324, WOOSTER, OH 44691-1967
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT006891
OH
Other
Enumeration date
08/18/2023
Last updated
08/18/2023
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