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General NPI Number Information
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NPI Number | 1053455337
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Entity Type | Individual
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Provider Name | MARIA I MORENO PT
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 410 SAYBROOK RD STE 100
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4780
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Country | US
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Telephone | 860-638-3820
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Fax | 860-638-3840
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Provider Business Mailing Address
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Address Line | 410 SAYBROOK RD STE 100
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4780
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Country | US
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Telephone | 860-638-3820
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Fax | 860-638-3840
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 4956
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4956
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 2251H1200X
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Taxonomy Name | Hand Physical Therapist
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License Number | 4956
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 4956
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 4956
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 4956
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License Number State | CT
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