Individual
MICHAEL SHANE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
2757 VANDY CT, MONTGOMERY, AL 36110-1339
(334) 669-1430
Mailing address
2757 VANDY CT, MONTGOMERY, AL 36110-1339
(334) 669-1430
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PTA9712
AL
Other
Enumeration date
08/17/2020
Last updated
08/17/2020
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