Provider Demographics
NPI:1578606612
Name:MOORE, MARGUERITE THERESA (PHD, ATC)
Entity Type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:THERESA
Last Name:MOORE
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Gender:F
Credentials:PHD, ATC
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Mailing Address - Street 1:47 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9450
Mailing Address - Country:US
Mailing Address - Phone:906-226-4549
Mailing Address - Fax:906-227-2181
Practice Address - Street 1:1401 PRESQUE ISLE, NORTHERN MICHIGAN UNIVERSITY
Practice Address - Street 2:SCHOOL OF HEALTH AND HUMAN PERFORMANCE, PEIF BUILDING
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2634
Practice Address - Country:US
Practice Address - Phone:906-227-2239
Practice Address - Fax:906-227-2181
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2014-02-05
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer