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NPI Code Detail

MEDICARE: MS. ALISON LEIGH MOORE LAT, ATC

MEDICARE: MS. ALISON LEIGH MOORE LAT, ATC
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
12255A2300XAthletic Trainer36001297AIN

General Provider Information

NPI Number : 1548371743
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALISON LEIGH MOORE LAT, ATC
Provider Business Mailing Address
First Line : 712 HERITAGE LN E
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47803-1379
Country : US
Telephone Number : 501-472-5400
Fax Number :
Provider Business Practice Location Address
First Line : 6TH AND CHESTNUT
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47809-0001
Country : US
Telephone Number : 501-472-5400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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