Provider Demographics
NPI:1457793705
Name:MOORE, MARGARET R (LMT, CMT)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7304
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-8077
Mailing Address - Country:US
Mailing Address - Phone:951-733-8868
Mailing Address - Fax:
Practice Address - Street 1:2395 HAMNER AVE
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2674
Practice Address - Country:US
Practice Address - Phone:951-736-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA008938172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist