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General NPI Number Information
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NPI Number | 1265833149
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Entity Type | Individual
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Provider Name | KASEY MOORE LMT
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Gender | Female
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 738 SW MAIN BLVD
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City | LAKE CITY
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State | FL
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Zip | 32025-5768
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Country | US
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Telephone | 386-400-3140
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Fax | 386-406-8013
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Provider Business Mailing Address
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Address Line | 434 SE WALDRON TER
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City | LAKE CITY
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State | FL
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Zip | 32025-5529
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Country | US
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Telephone | 386-400-3140
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Fax | 386-406-8013
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA73189
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License Number State | FL
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