Healthcare Provider Details

I. General information

NPI: 1003594870
Provider Name (Legal Business Name): LANEY MARIE MOFFITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 S UNIVERSITY BLVD STE 400
CENTENNIAL CO
80122-1510
US

IV. Provider business mailing address

9850 ZENITH MERIDIAN DR APT 14-106
ENGLEWOOD CO
80112-6329
US

V. Phone/Fax

Practice location:
  • Phone: 303-771-5120
  • Fax:
Mailing address:
  • Phone: 605-381-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0015375
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: