Provider Demographics
NPI:1679796346
Name:MOORE, KYOUNG HUI (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:KYOUNG
Middle Name:HUI
Last Name:MOORE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 SHADY LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-6544
Mailing Address - Country:US
Mailing Address - Phone:254-793-3904
Mailing Address - Fax:
Practice Address - Street 1:2901 W STAN SCHLUETER LOOP STE 400
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-3746
Practice Address - Country:US
Practice Address - Phone:254-449-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT039932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist