Individual
KIM MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
148 NW 1150TH RD, CHILHOWEE, MO 64733-8107
(660) 525-6267
Mailing address
PO BOX 142, WINDSOR, MO 65360-0142
(660) 525-6267
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2010028284
MO
Other
Enumeration date
12/16/2014
Last updated
12/16/2014
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