MEDICARE: KIMBERLY ANN MOORE

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1841568706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN MOORE

Provider Business Mailing Address
First Line	:	1109 W 21ST ST
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-2831
Country	:	US
Telephone Number	:	913-620-8220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 W 21ST ST
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-2831
Country	:	US
Telephone Number	:	913-620-8220
Fax Number	:

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

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	12/07/2011

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Directions to “ KIMBERLY ANN MOORE ” Practice Location

Language	Start Address	Practice Location

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