Provider Demographics
NPI:1033313416
Name:MOORE, RONNA ANN (PTA)
Entity Type:Individual
Prefix:
First Name:RONNA
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29025 HIGHWAY O
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-7718
Mailing Address - Country:US
Mailing Address - Phone:417-462-3168
Mailing Address - Fax:
Practice Address - Street 1:331 HOSPITAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-9217
Practice Address - Country:US
Practice Address - Phone:417-533-6315
Practice Address - Fax:417-533-6320
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001000666225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant