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NPI Code Detail

MEDICARE: DEVONIA MOORE LMBT

MEDICARE: DEVONIA MOORE LMBT
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
1225700000XMassage Therapist19883NC

General Provider Information

NPI Number : 1952165961
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVONIA MOORE LMBT
Provider Business Mailing Address
First Line : 806 STAMPER RD STE 201
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-4100
Country : US
Telephone Number : 910-818-2513
Fax Number : 910-401-1030
Provider Business Practice Location Address
First Line : 806 STAMPER RD STE 201
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28303-4100
Country : US
Telephone Number : 910-818-2513
Fax Number : 910-401-1030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2024
Last Update Date : 02/09/2024

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