Healthcare Provider Details

I. General information

NPI: 1558116012
Provider Name (Legal Business Name): JENNA MORANSKI PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 BARCLAY DOWNS DR
CHARLOTTE NC
28210-4953
US

IV. Provider business mailing address

1799 ROBINWOOD RD
GASTONIA NC
28054-1621
US

V. Phone/Fax

Practice location:
  • Phone: 980-224-8540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21086
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: