Most Relevant Information
Provider Data
| NPI Number: | 1003490236 |
| Provider Name: | TYLEKA MOORE |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: | PT012440 |
Most Important Dates
| Enumeration Date: | 05/12/2021 |
| Last Updated: | 05/12/2021 |
Provider Practice Location
199 MEDICAL BLVD
STOCKBRIDGE
GA
302815083
Practice Location Phone/Fax
| Phone: | 4707819440 |
| Fax: |
Provider Mailing Location
100 WEEPING WILLOW WAY
WARNER ROBINS
GA
310938525
Provider Mailing Phone/Fax
| Phone: | 4789736889 |
| Fax: |