Individual
CHARLES MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
549 NW LAKE WHITNEY PL STE 103, PORT ST LUCIE, FL 34986-1606
(772) 242-3187
Mailing address
549 NW LAKE WHITNEY PL STE 103, PORT ST LUCIE, FL 34986-1606
(772) 242-3187
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SZ 7830
FL
Other
Enumeration date
09/24/2016
Last updated
09/24/2016
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