Provider Demographics
NPI:1215577846
Name:MOORE, MELISSA CATHERINE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:CATHERINE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 JONES RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-7751
Mailing Address - Country:US
Mailing Address - Phone:334-796-9087
Mailing Address - Fax:
Practice Address - Street 1:1789 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-3733
Practice Address - Country:US
Practice Address - Phone:334-796-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4543225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist