MEDICARE: MARY COLLEEN MORETTO 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
1	225100000X	Physical Therapist	007817	NY

General Provider Information

NPI Number	:	1255370821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY COLLEEN MORETTO PT

Provider Business Mailing Address
First Line	:	333 BROADWAY
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-5301
Country	:	US
Telephone Number	:	845-562-1054
Fax Number	:	845-562-6148

Provider Business Practice Location Address
First Line	:	333 BROADWAY
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-5301
Country	:	US
Telephone Number	:	845-562-1054
Fax Number	:	845-562-6148

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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