Provider Demographics
NPI:1245381730
Name:MOORE, AARON LOUIS (MT, PT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:LOUIS
Last Name:MOORE
Suffix:
Gender:M
Credentials:MT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-1340
Mailing Address - Country:US
Mailing Address - Phone:708-473-2875
Mailing Address - Fax:
Practice Address - Street 1:3901 TOWER DR
Practice Address - Street 2:SUITE B502
Practice Address - City:RICHTON PARK
Practice Address - State:IL
Practice Address - Zip Code:60471-1340
Practice Address - Country:US
Practice Address - Phone:708-473-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist