Provider Demographics
NPI:1275562670
Name:MOORE, CELIA (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:CELIA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8285 NEWCASTLE LN
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115-3119
Mailing Address - Country:US
Mailing Address - Phone:540-364-4285
Mailing Address - Fax:
Practice Address - Street 1:8285 NEWCASTLE LN
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:VA
Practice Address - Zip Code:20115-3119
Practice Address - Country:US
Practice Address - Phone:540-364-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer