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NPI Code Detail

MEDICARE: MRS. MARY KATHERINE MOREAU PT

MEDICARE: MRS. MARY KATHERINE MOREAU PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251P0200XPediatric Physical TherapistPT20131FL

General Provider Information

NPI Number : 1114937976
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY KATHERINE MOREAU PT
Provider Business Mailing Address
First Line : 4 JACKSON ST NE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548-4925
Country : US
Telephone Number : 850-862-7227
Fax Number : 850-862-2421
Provider Business Practice Location Address
First Line : 4 JACKSON ST NE
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32548-4925
Country : US
Telephone Number : 850-862-7227
Fax Number : 850-862-2421
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 07/08/2007

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