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General NPI Number Information
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NPI Number | 1790749539
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Entity Type | Individual
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Provider Name | BRIAN KEITH MOORE MS, ATC
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Gender | Male
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4653 CLAIRTON BLVD
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City | PITTSBURGH
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State | PA
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Zip | 15236-2149
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Country | US
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Telephone | 412-885-7515
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Fax | 412-885-6652
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Provider Business Mailing Address
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Address Line | 1552 CATHELL RD
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City | PITTSBURGH
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State | PA
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Zip | 15236-1110
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Country | US
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Telephone | 412-668-0481
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | RT000803A
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License Number State | PA
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