KEVIN DWAYNE MOORE

COEUR D ALENE, ID
NPI1124286109
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: ID  PTA344)
Enumeration Date2008-05-27
Last Update Date2008-05-27
Business Address
MR. KEVIN DWAYNE MOORE PTA
500 W AQUA AVE
COEUR D ALENE, ID 83815-7764
Phone number: 208-762-1122
Mailing Address
MR. KEVIN DWAYNE MOORE PTA
500 W AQUA AVE
COEUR D ALENE, ID 83815-7764
Phone number: 208-762-1122
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