Individual
KIM REAVIS MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3000 BETHESDA PL STE 701, WINSTON SALEM, NC 27103-3329
(336) 399-9764
Mailing address
217 RIDGEVIEW DR, MOUNT AIRY, NC 27030-7784
(336) 399-9764
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
53
NC
Other
Enumeration date
06/13/2021
Last updated
06/13/2021
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