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General NPI Number Information
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NPI Number | 1396949723
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Entity Type | Individual
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Provider Name | ELLEN MARIE MORAN P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 7090 COVENANT WOODS DR
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-7025
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Country | US
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Telephone | 804-559-8936
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Fax |
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Provider Business Mailing Address
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Address Line | 14101 SHAWHAN PL
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-3306
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Country | US
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Telephone | 804-594-7239
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305205421
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License Number State | VA
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