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General NPI Number Information
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NPI Number | 1649930470
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Entity Type | Individual
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Provider Name | ALISIA ANTONETTE MOORE LMT, CMT, CNMT, MMT
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Gender | Female
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Dates
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Enumeration Date | 12/21/2021
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 3160 ARDEN WAY
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City | SACRAMENTO
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State | CA
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Zip | 95825-3700
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Country | US
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Telephone | 916-296-7348
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Fax |
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Provider Business Mailing Address
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Address Line | 6090 S LAND PARK DR APT 41
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City | SACRAMENTO
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State | CA
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Zip | 95822-3344
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Country | US
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Telephone | 916-296-7348
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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 | 88705
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License Number State | CA
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