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General NPI Number Information
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NPI Number | 1487130456
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Entity Type | Individual
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Provider Name | STEPHANIE CRYSTEN MORELAND
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Gender | Female
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 13030 WARWICK BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-8374
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Country | US
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Telephone | 757-249-0355
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Fax |
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Provider Business Mailing Address
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Address Line | 203 DAPHNE DR
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City | YORKTOWN
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State | VA
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Zip | 23692-3200
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Country | US
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Telephone | 423-702-0475
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306604395
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License Number State | VA
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