Provider Demographics
NPI:1558067579
Name:MOORE MASSAGE LLC
Entity type:Organization
Organization Name:MOORE MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:386-400-3140
Mailing Address - Street 1:434 SE WALDRON TERRACE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025
Mailing Address - Country:US
Mailing Address - Phone:904-437-9823
Mailing Address - Fax:386-406-8013
Practice Address - Street 1:738 SW MAIN BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5768
Practice Address - Country:US
Practice Address - Phone:904-437-9823
Practice Address - Fax:386-406-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1114742079OtherINDIVIDUAL NPI
FL1821862426OtherINDIVIDUAL NPI
FL1265833149OtherINDIVIDUAL NPI
FL1326856618OtherINDIVIDUAL NPI