Provider Demographics
NPI:1932591773
Name:MOORE, STEPHANIE DIANE (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:DIANE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:D
Other - Last Name:MOORE-REED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, ATC
Mailing Address - Street 1:5275 N CAMPUS DR
Mailing Address - Street 2:M/S SG28
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93740-0001
Mailing Address - Country:US
Mailing Address - Phone:559-278-0255
Mailing Address - Fax:
Practice Address - Street 1:5275 N CAMPUS DR
Practice Address - Street 2:M/S SG28
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93740-0001
Practice Address - Country:US
Practice Address - Phone:559-278-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer