Provider Demographics
NPI:1639757917
Name:MOORE, JANAE LEIGH (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:LEIGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20548 OLD JASPER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-1801
Mailing Address - Country:US
Mailing Address - Phone:205-522-4144
Mailing Address - Fax:
Practice Address - Street 1:3409 MCFARLAND BLVD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3178
Practice Address - Country:US
Practice Address - Phone:205-333-2220
Practice Address - Fax:205-333-2461
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3099225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL225700000XOtherOPTUM