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General NPI Number Information
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NPI Number | 1639757917
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Entity Type | Individual
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Provider Name | JANAE LEIGH MOORE MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 3409 MCFARLAND BLVD
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City | NORTHPORT
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State | AL
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Zip | 35476-3178
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Country | US
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Telephone | 205-333-2220
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Fax | 205-333-2461
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Provider Business Mailing Address
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Address Line | 20548 OLD JASPER RD
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City | NORTHPORT
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State | AL
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Zip | 35475-1801
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Country | US
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Telephone | 205-522-4144
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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 | 3099
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License Number State | AL
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