Individual
GLENN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
4150 N ARMENIA AVE STE 102, TAMPA, FL 33607-6448
(813) 877-6900
Mailing address
4150 N ARMENIA AVE STE 102, TAMPA, FL 33607-6448
(813) 877-6900
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA82864
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510610148
OWCP
FL
Enumeration date
04/26/2021
Last updated
04/26/2021
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