Provider Demographics
NPI:1710131065
Name:MOORE, MARTHA F (LMT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:F
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 SW 31ST AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6922
Mailing Address - Country:US
Mailing Address - Phone:954-547-3749
Mailing Address - Fax:
Practice Address - Street 1:5201 SW 31ST AVE APT 105
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6922
Practice Address - Country:US
Practice Address - Phone:954-547-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA38723225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist