Individual
LESHANTE A. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
612 DENBIGH BLVD, NEWPORT NEWS, VA 23608-4416
(757) 874-0032
(757) 874-0127
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(630) 575-6200
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305211611
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
11/01/2017
Last updated
12/20/2024
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