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General NPI Number Information
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NPI Number | 1497401277
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Entity Type | Individual
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Provider Name | KEITH MOORE CR, LMT
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Gender | Male
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 10410 KENSINGTON PKWY STE 207
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City | KENSINGTON
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State | MD
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Zip | 20895-2947
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Country | US
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Telephone | 202-437-2507
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Fax |
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Provider Business Mailing Address
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Address Line | 3938 LANTERN DR
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City | SILVER SPRING
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State | MD
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Zip | 20902-2321
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Country | US
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Telephone | 202-437-2507
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M04099
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License Number State | MD
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