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General NPI Number Information
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NPI Number | 1215994553
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Entity Type | Individual
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Provider Name | LANA J MOORE MS RPT
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Gender | Female
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 916 SW 38TH ST SUITE C
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City | LAWTON
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State | OK
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Zip | 73505
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Country | US
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Telephone | 580-353-1490
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Fax | 580-250-1651
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Provider Business Mailing Address
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Address Line | 885 SW COUNTRY HWY 115
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City | CACHE
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State | OK
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Zip | 73527-4727
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Country | US
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Telephone | 580-429-8569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT1691
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License Number State | OK
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