Individual
MRS. TABITHA JANE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3415 SHERIDAN RD, KENOSHA, WI 53140-1924
(262) 657-6175
Mailing address
8616 FOX HAVEN CHASE, STURTEVANT, WI 53177-2973
(414) 429-4380
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
247-19
WI
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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