Healthcare Provider Details

I. General information

NPI: 1235525536
Provider Name (Legal Business Name): ANTHONY LOUIS MORETTI SR. RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SAN MIGUEL DR APARTMENT J
SAINT CHARLES MO
63303-3294
US

IV. Provider business mailing address

15 SAN MIGUEL DR APARTMENT J
SAINT CHARLES MO
63303-3294
US

V. Phone/Fax

Practice location:
  • Phone: 314-606-0875
  • Fax:
Mailing address:
  • Phone: 314-606-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number101196
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: