Provider Demographics
NPI:1740650183
Name:MOORE, ANNA MARIE (PTA)
Entity type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LOST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8407
Mailing Address - Country:US
Mailing Address - Phone:731-444-4444
Mailing Address - Fax:
Practice Address - Street 1:8017 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-6805
Practice Address - Country:US
Practice Address - Phone:731-686-8373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6114225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant