Provider Demographics
NPI:1215994553
Name:MOORE, LANA J (MS RPT)
Entity type:Individual
Prefix:MRS
First Name:LANA
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS RPT
Other - Prefix:MISS
Other - First Name:LANA
Other - Middle Name:J
Other - Last Name:MCCRACKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RPT
Mailing Address - Street 1:885 SW COUNTRY HWY 115
Mailing Address - Street 2:
Mailing Address - City:CACHE
Mailing Address - State:OK
Mailing Address - Zip Code:73527-4727
Mailing Address - Country:US
Mailing Address - Phone:580-429-8569
Mailing Address - Fax:
Practice Address - Street 1:916 SW 38TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505
Practice Address - Country:US
Practice Address - Phone:580-353-1490
Practice Address - Fax:580-250-1651
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist