Individual
MRS. JESSICA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
1100 BLYTHE BLVD, CHARLOTTE, NC 28203-5814
(704) 355-8674
Mailing address
1100 BLYTHE BLVD, CHARLOTTE, NC 28203-5814
(704) 355-8674
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A4488
NC
Other
Enumeration date
09/19/2019
Last updated
09/19/2019
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