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Individual

MIKAYLA ASHLYN MOORE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MAT, ATC

Contact information

Practice address
14701 COPPER RIDGE BLVD, TYLER, TX 75706-3364
(903) 714-3515
Mailing address
14701 COPPER RIDGE BLVD, TYLER, TX 75706-3364
(903) 714-3515

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000023668
TX

Other

Enumeration date
05/25/2016
Last updated
05/25/2016
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