MEDICARE: JOY LINDA MOORE LMP

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	MA.60021983	WA

General Provider Information

NPI Number	:	1831332360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY LINDA MOORE LMP

Provider Business Mailing Address
First Line	:	12525 E. MISSION AVE
Second Line	:	#104
City	:	SPOKANE
State	:	WA
Zip	:	99216-1079
Country	:	US
Telephone Number	:	509-928-1500
Fax Number	:	509-928-8006

Provider Business Practice Location Address
First Line	:	12525 E. MISSION AVE
Second Line	:	#104
City	:	SPOKANE
State	:	WA
Zip	:	99216-1079
Country	:	US
Telephone Number	:	509-928-1500
Fax Number	:	509-928-8006

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

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	04/14/2009

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