Provider Demographics
NPI:1841894995
Name:MOORE, BRITTANI (LAT ATC)
Entity type:Individual
Prefix:MS
First Name:BRITTANI
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LAT ATC
Other - Prefix:
Other - First Name:BRITTANI
Other - Middle Name:M
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT ATC
Mailing Address - Street 1:5228 THRASHER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-3563
Mailing Address - Country:US
Mailing Address - Phone:317-281-5539
Mailing Address - Fax:
Practice Address - Street 1:5228 THRASHER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-3563
Practice Address - Country:US
Practice Address - Phone:317-281-5539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001755A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2330864354OtherCASH