Individual
AUDRA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
200 GASTON AVE, FAIRMONT, WV 26554-2739
(203) 624-6554
(304) 624-5223
Mailing address
200 GASTON AVE, FAIRMONT, WV 26554-2739
(203) 624-6554
(304) 624-5223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2037
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7302178000
—
WV
Enumeration date
03/04/2008
Last updated
03/04/2008
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