MEDICARE: KATHY ANN MOORE LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	1128	NC

General Provider Information

NPI Number	:	1144423104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY ANN MOORE LMT

Provider Business Mailing Address
First Line	:	120 PERRY DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27530-8520
Country	:	US
Telephone Number	:	919-736-8503
Fax Number	:

Provider Business Practice Location Address
First Line	:	1318 WAYNE MEMORIAL DR STE B
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-2255
Country	:	US
Telephone Number	:	919-735-7447
Fax Number	:	919-735-7402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/08/2007

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