Provider Demographics
NPI:1063913390
Name:MOORE, TARYN LEIGH (ATC, LAT)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:LEIGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 SAND DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-6856
Mailing Address - Country:US
Mailing Address - Phone:843-696-8061
Mailing Address - Fax:
Practice Address - Street 1:355 FRONT ST
Practice Address - Street 2:
Practice Address - City:NEW WAVERLY
Practice Address - State:TX
Practice Address - Zip Code:77358-3527
Practice Address - Country:US
Practice Address - Phone:936-291-6451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer