MEDICARE: MS. JULIE A MORITZ MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4395	CO

General Provider Information

NPI Number	:	1073821435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE A MORITZ MSPT

Provider Business Mailing Address
First Line	:	6636 HOLYOKE CT.
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-518-9753
Fax Number	:

Provider Business Practice Location Address
First Line	:	4750 PLEASANT OAK DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3737
Country	:	US
Telephone Number	:	970-226-8535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2010
Last Update Date	:	10/04/2010

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