Healthcare Provider Details

I. General information

NPI: 1427972942
Provider Name (Legal Business Name): PATRICIA ANN MOORE MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 WILEY PARKER RD STE H
JACKSON TN
38305-5806
US

IV. Provider business mailing address

PO BOX 220
TROY TN
38260-0220
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-0900
  • Fax:
Mailing address:
  • Phone: 731-446-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT10777
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: