Provider Demographics
NPI:1538499157
Name:MOORE, COURTNEY KEESE (LAC, CMT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KEESE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LAC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3664A 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1504
Mailing Address - Country:US
Mailing Address - Phone:541-760-9297
Mailing Address - Fax:
Practice Address - Street 1:605 CHENERY STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2956
Practice Address - Country:US
Practice Address - Phone:415-585-1990
Practice Address - Fax:415-585-1990
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
CA15519171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist