Healthcare Provider Details

I. General information

NPI: 1518807759
Provider Name (Legal Business Name): TARCISIO SANTOS MOREIRA PT, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 GLENN AVE
COVINGTON KY
41015-1641
US

IV. Provider business mailing address

1258 DAY CIR E
MILFORD OH
45150-2303
US

V. Phone/Fax

Practice location:
  • Phone: 859-431-2244
  • Fax:
Mailing address:
  • Phone: 513-238-7126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number022248
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number022248
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: