Individual
LISA ANN MOORE
Active
Individual
LISA ANN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.P.T., OCS
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9804
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0396460
—
MA
01
—
1294660
FALLON
MA
01
—
470239
TUFTS
MA
01
—
Y68106
BCBS
MA
Enumeration date
09/28/2006
Last updated
02/01/2021
Update your record
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