Provider Demographics
NPI:1720702921
Name:MOORE, AMANDA MICHELLE (RESPIRATORY THERAPIS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RESPIRATORY THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 COUNTY ROAD 255
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35740-7425
Mailing Address - Country:US
Mailing Address - Phone:256-695-7348
Mailing Address - Fax:
Practice Address - Street 1:205 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:AL
Practice Address - Zip Code:35772-3103
Practice Address - Country:US
Practice Address - Phone:256-695-7348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies