Basic Information
| Provider Information | |||||||||
| NPI: | 1649379421 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 TEDINGTON | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394027790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015797549 | ||||||||
| FaxNumber: | 2563507757 | ||||||||
| Practice Location | |||||||||
| Address1: | 3688 VETERANS MEMORIAL DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394018246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015430221 | ||||||||
| FaxNumber: | 6015430201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PT1033 | MS | Y | Other Service Providers | Specialist |
No ID Information.