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NPI Code Detail

MEDICARE: MICHAEL JAMES MORIARTY PTA

MEDICARE: MICHAEL JAMES 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
1225200000XPhysical Therapy Assistant2102892TX

General Provider Information

NPI Number : 1518447499
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL JAMES MORIARTY PTA
Provider Business Mailing Address
First Line : 3838 E SOUTHCROSS BLVD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78222-3556
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3838 E SOUTHCROSS BLVD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78222-3556
Country : US
Telephone Number : 210-581-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2018
Last Update Date : 08/20/2018

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