Lily Mae Moore, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA94304 Issued in FL

Practice address

350 79TH Ave N Apt 210
St Petersburg, FL 33702-4456

Phone

(586) 291-0309

NPI assigned

Nov 19, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1972106102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 79TH AVE N APT 210",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337024456",
            "telephone_number": "586-291-0309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 79TH AVE N APT 210",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337024456",
            "telephone_number": "586-291-0309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "LILY",
        "middle_name": "MAE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-19",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA94304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clint Alexander Moore, CBHCHS CASE MGMT.
• Denise S Moore, ARNP
• Donovan Moore
• Kylie Moore
• Laurel Moore
• Madison Moore
• Mariah Dawn Moore, M.S. CF-SLP
• Natalie Nicole Moore, CRNA
• Sandra M Moore, R.PH.
• Shawanda Lassettte Moore, MSN, BS, RN

• Massage Therapist in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.