Provider Demographics
NPI:1003553819
Name:MOORE, ANDREA R (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 BRINKLEY RD APT 101
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6056
Mailing Address - Country:US
Mailing Address - Phone:301-758-0029
Mailing Address - Fax:
Practice Address - Street 1:2917 BRINKLEY RD APT 101
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6056
Practice Address - Country:US
Practice Address - Phone:301-758-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist