Provider Demographics
NPI:1174237069
Name:MOORE, LAUREN (LMT, NTS, NASM-CPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMT, NTS, NASM-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 6TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1337
Mailing Address - Country:US
Mailing Address - Phone:505-280-3213
Mailing Address - Fax:
Practice Address - Street 1:2501 SAN PEDRO DR NE STE 117
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4156
Practice Address - Country:US
Practice Address - Phone:505-209-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8720225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist