Healthcare Provider Details

I. General information

NPI: 1164144515
Provider Name (Legal Business Name): LOREN MOORER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2976 CHAPEL HILL RD STE 200
DOUGLASVILLE GA
30135-1849
US

IV. Provider business mailing address

900 CIRCLE 75 PKWY SE STE 1700
ATLANTA GA
30339-3087
US

V. Phone/Fax

Practice location:
  • Phone: 770-949-8558
  • Fax: 770-949-6966
Mailing address:
  • Phone: 678-996-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016254
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: