Provider Demographics
NPI:1144423104
Name:MOORE, KATHY ANN (LMT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
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 1:120 PERRY DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-8520
Mailing Address - Country:US
Mailing Address - Phone:919-736-8503
Mailing Address - Fax:
Practice Address - Street 1:1318 WAYNE MEMORIAL DR STE B
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2255
Practice Address - Country:US
Practice Address - Phone:919-735-7447
Practice Address - Fax:919-735-7402
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1128225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist