Individual
KATHLEEN M MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
50 MULBERRY TREE ST, CHARLES TOWN, WV 25414-1274
(304) 724-1101
Mailing address
23 FRYE CT, LOVETTSVILLE, VA 20180-8619
(540) 822-5458
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
001672
WV
Other
Enumeration date
04/25/2012
Last updated
04/25/2012
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