Individual
RONALD PETE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2312 S DIXON RD, KOKOMO, IN 46902-6401
(765) 210-6850
Mailing address
2108 N 300 W, KOKOMO, IN 46901-8375
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004440A
IN
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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