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General NPI Number Information
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NPI Number | 1730437534
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Entity Type | Individual
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Provider Name | SARAH RAEANN MOORE DPT
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Gender | Female
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 211 S CURTIS ST
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City | LAKE GENEVA
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State | WI
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Zip | 53147-2052
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Country | US
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Telephone | 262-248-3145
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Fax |
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Provider Business Mailing Address
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Address Line | 409 FRANKLIN ST
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City | BELVIDERE
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State | IL
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Zip | 61008-3410
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Country | US
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Telephone | 815-978-1645
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12050-24
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070021329
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License Number State | IL
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