Moore, Audra

Moore, Audra is an sole proprietor health care provider with primary practice located at 200 Gaston Ave , Fairmont WV 26554-2739. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as her primary health care specialty. Moore, Audra can be contacted via phone (203) 624-6554.

Contact Information

Primary practice address
200 Gaston Ave Fairmont WV 26554-2739
Phone: (203) 624-6554
Fax: (304) 624-5223
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 2037 West Virginia

Profile Details

NPI number 1689844789
LBN Legal business name Moore, Audra
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 4th, 2008
Last updated Mar 4th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689844789 NPPES
West Virginia MEDICAID 7302178000

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