Provider Demographics
NPI:1881490944
Name:MOORE, ALEXANDRA DANIELLE
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:DANIELLE
Last Name:MOORE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 COURTHOUSE RD APT 1012
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-4289
Mailing Address - Country:US
Mailing Address - Phone:601-723-0396
Mailing Address - Fax:
Practice Address - Street 1:368 COURTHOUSE RD STE D
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1854
Practice Address - Country:US
Practice Address - Phone:228-860-9539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2021225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist