Provider Demographics
NPI:1518289651
Name:MOORE, NEIL A (MS, ATC/LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:A
Last Name:MOORE
Suffix:
Gender:M
Credentials:MS, ATC/LAT, CSCS
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1111 N GLENSTONE AVE
Mailing Address - Street 2:ATHLETIC TRAINING ROOM-ASHCROFT CENTER
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-2125
Mailing Address - Country:US
Mailing Address - Phone:417-865-2815
Mailing Address - Fax:417-575-5494
Practice Address - Street 1:1111 N GLENSTONE AVE
Practice Address - Street 2:ATHLETIC TRAINING ROOM-ASHCROFT CENTER
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-2125
Practice Address - Country:US
Practice Address - Phone:417-865-2815
Practice Address - Fax:417-575-5494
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20020195852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer