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General NPI Number Information
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NPI Number | 1700250495
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Entity Type | Individual
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Provider Name | TIFFANY MOORE LMT
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Gender | Female
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 2930 E LEFFEL LN
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City | SPRINGFIELD
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State | OH
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Zip | 45505-4540
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Country | US
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Telephone | 937-418-5545
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Fax |
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Provider Business Mailing Address
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Address Line | 2939 KENNY RD SUITE 195
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City | COLUMBUS
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State | OH
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Zip | 43221-2406
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Country | US
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Telephone | 937-418-5545
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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 | 33.016454
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License Number State | OH
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