Healthcare Provider Details

I. General information

NPI: 1275712788
Provider Name (Legal Business Name): STEVEN T MOREAU PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 WESTERN AVE
PORTLAND ME
04106-2432
US

IV. Provider business mailing address

2318 COUNTY ROAD 39
BLOOMFIELD NY
14469-9507
US

V. Phone/Fax

Practice location:
  • Phone: 207-879-7510
  • Fax:
Mailing address:
  • Phone: 585-657-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT1252
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: