NPI 1306688528

Terence Moore

Practitioner Massage Therapist Glen Ellyn, IL

Practice location

Address: 92 Tanglewood Dr, Glen Ellyn, IL 60137-7831
Phone: (336) 898-4786
Mailing address: 539 W Roosevelt Rd #1083, Glen Ellyn, IL 60137

Registered specialties

Massage Therapist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225700000X Licence 227.022710 (IL)

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Registry record

NPI: 1306688528
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Jun 2024
Record last updated: 10 Jun 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.