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NPI Code Detail

MEDICARE: MRS. ELLEN MARIE MORAN P.T.

MEDICARE: MRS. ELLEN MARIE MORAN P.T.
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
1225100000XPhysical Therapist2305205421VA

General Provider Information

NPI Number : 1396949723
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELLEN MARIE MORAN P.T.
Provider Business Mailing Address
First Line : 14101 SHAWHAN PL
Second Line :
City : MIDLOTHIAN
State : VA
Zip : 23114-3306
Country : US
Telephone Number : 804-594-7239
Fax Number :
Provider Business Practice Location Address
First Line : 7090 COVENANT WOODS DR
Second Line :
City : MECHANICSVILLE
State : VA
Zip : 23111-7025
Country : US
Telephone Number : 804-559-8936
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2007
Last Update Date : 10/07/2014

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