Provider Demographics
NPI:1467437301
Name:MOORE, KRISTI DAWN (PT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:DAWN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8951 W SAHARA AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5898
Mailing Address - Country:US
Mailing Address - Phone:702-675-3777
Mailing Address - Fax:702-233-2289
Practice Address - Street 1:8951 W SAHARA AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5898
Practice Address - Country:US
Practice Address - Phone:702-675-3777
Practice Address - Fax:702-233-2289
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2281225100000X
CA27972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist