Doctor Name: | MARY MOORE |
NPI Number: | 1013391630 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MASSAGE THERAPIST |
License Number: | 0019009694 |
Business Practice Address: | 2049 Jefferson Davis Hwy Stafford, VA - 225547292 |
Business Phone Number: | 5406571423 |
Business Fax Number: | |
Mailing Address: | 4105 Monticello St, FREDERICKSBURG |
State: | VA |
Postal Code: | 224089561 |
Phone Number: | 5402873706 |
Fax Number: | |
NPI Enumeration Date: | 07/14/2015 |
NPI Last Update Date: | 07/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 0019009694 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |