MEDICARE: SUZANNE BARNEY MORIARTY PTA

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	225200000X	Physical Therapy Assistant	PTA16919	FL

General Provider Information

NPI Number	:	1144237850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUZANNE BARNEY MORIARTY PTA

Provider Business Mailing Address
First Line	:	5336 WHITTEN DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34104-5301
Country	:	US
Telephone Number	:	239-261-1915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 HERITAGE TRL
Second Line	:	SUITE 301
City	:	NAPLES
State	:	FL
Zip	:	34112-8716
Country	:	US
Telephone Number	:	239-649-6848
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/08/2007

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