Healthcare Provider Details

I. General information

NPI: 1437393428
Provider Name (Legal Business Name): REBEKAH C MOORE CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 E COUNTY LINE RD SUITE M
GREENWOOD IN
46143-1075
US

IV. Provider business mailing address

311 N LYNHURST DR
INDIANAPOLIS IN
46224-8823
US

V. Phone/Fax

Practice location:
  • Phone: 317-881-8119
  • Fax:
Mailing address:
  • Phone: 317-908-5681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: