Provider Demographics
NPI:1497358204
Name:MOORE, SHERGAIL (CMT)
Entity Type:Individual
Prefix:
First Name:SHERGAIL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41606 CIELO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1607
Mailing Address - Country:US
Mailing Address - Phone:314-265-8502
Mailing Address - Fax:866-315-3848
Practice Address - Street 1:38434 9TH ST E STE B2
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4707
Practice Address - Country:US
Practice Address - Phone:844-230-9399
Practice Address - Fax:866-315-3848
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85305225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist