Individual
MS. MELISSA RAE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
401 IDAHO AVE, ORDWAY, CO 81063-1328
(877) 306-0051
Mailing address
4216 SENTINEL PL, PUEBLO, CO 81008-1877
(719) 423-9462
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
01/04/2012
Last updated
01/04/2012
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