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General NPI Number Information
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NPI Number | 1528462546
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Entity Type | Individual
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Provider Name | LESLIE MOORE L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 2160 PRESTON PKWY
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City | PERRYSBURG
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State | OH
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Zip | 43551-7254
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Country | US
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Telephone | 567-246-9101
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Fax |
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Provider Business Mailing Address
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Address Line | 12331 WATERSTONE LN APT 717
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City | PERRYSBURG
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State | OH
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Zip | 43551-3045
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Country | US
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Telephone | 567-246-9101
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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 | 33.020331-L-M
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License Number State | OH
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