Individual
MRS. COLEEN LEANN MOORE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1801 FOREST HILLS BLVD, STE 205, BELLA VISTA, AR 72715
(479) 855-9348
(479) 855-9358
Mailing address
PO BOX 841, HARRISON, AR 72602-0841
(870) 743-5573
(870) 743-5974
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT388
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5T496
BCBS
—
Enumeration date
04/28/2006
Last updated
07/08/2007
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