Provider Demographics
NPI:1285311654
Name:MOORE, HANNAH RUTH (PTA)
Entity type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:RUTH
Last Name:MOORE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:320 LINDENHURST DR APT 18208
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1388
Mailing Address - Country:US
Mailing Address - Phone:859-457-5852
Mailing Address - Fax:
Practice Address - Street 1:3051 RIO DOSA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1545
Practice Address - Country:US
Practice Address - Phone:859-381-7931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA04271225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant