Individual
MR. TROY LANCE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT, ATC
Contact information
Practice address
300 N PARK AVE, ELLINWOOD, KS 67526-1452
(620) 564-2548
(620) 564-2079
Mailing address
300 N PARK AVE, ELLINWOOD, KS 67526-1452
(620) 564-2548
(620) 564-2079
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
11-03659
KS
225100000X
Physical Therapist
T-00797
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200400390A
—
KS
Enumeration date
09/05/2006
Last updated
01/21/2025
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