Individual
SALLY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1739 ELM CT, JEFFERSON CITY, MO 65101-4303
(573) 681-0445
Mailing address
127 DEL MAR DR, JEFFERSON CITY, MO 65109-6146
(573) 424-0566
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2004022996
MO
Other
Enumeration date
08/27/2016
Last updated
08/27/2016
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