Individual
LAURA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
75 E 400 N, RUPERT, ID 83350-9571
(208) 431-8386
Mailing address
75 E 400 N, RUPERT, ID 83350-9571
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4619
ID
Other
Enumeration date
05/04/2016
Last updated
05/04/2016
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