Provider Demographics
NPI:1790181006
Name:MOORE, JAMES (MS, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:KS
Mailing Address - Zip Code:67063-1753
Mailing Address - Country:US
Mailing Address - Phone:620-947-3121
Mailing Address - Fax:
Practice Address - Street 1:400 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:KS
Practice Address - Zip Code:67063-1753
Practice Address - Country:US
Practice Address - Phone:620-947-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-003982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer