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General NPI Number Information
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NPI Number | 1902412265
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Entity Type | Individual
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Provider Name | VICTORIA RAQUEL MORENO DPT
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Gender | Female
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 7585 KITTY HAWK
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City | CONVERSE
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State | TX
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Zip | 78109-2813
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Country | US
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Telephone | 210-236-0911
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Fax |
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Provider Business Mailing Address
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Address Line | 11539 HUEBNER RD APT 3412
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City | SAN ANTONIO
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State | TX
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Zip | 78230-1775
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Country | US
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Telephone |
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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 | 1335460
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License Number State | TX
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