MISS Susan Renee Moore, ATC, MS, LAT

NPI #1881903896 in Wesson, Mississippi

Provider Information

NPI Number: 1881903896
Entity Type: Individual
Name: MISS Susan Renee Moore, ATC, MS, LAT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Credential: ATC, MS, LAT
Enumeration Date: Sep 26, 2010
Last Updated: Sep 26, 2010

Practice Location

Address: 9030 MONTICELLO RD
City: Wesson
State: Mississippi
ZIP Code: 39191-9027
Phone: (601) 668-2932

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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