MEDICARE: AMY T MOORADIAN DPT

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	009106	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00322419	OTHER	RI	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050513332	OTHER	RI	GREATWEST
3	050513332	OTHER	RI	CHAMPUS
4	103959900	OTHER	RI	USDE
5	26848	OTHER	RI	BLUE CROSS BLUE SHIELD RI
6	5669517	OTHER	RI	COVENTRY HEALTH FIRST HEA
7	9378895	OTHER	RI	PHCS
8	268480	OTHER	RI	BLUE CROSS PROVIDER NUMBE
9	050513332	OTHER	RI	UNITED HEALTHCARE
10	411015	OTHER	RI	BLUE CHIP RI
11	779850	OTHER	RI	AETNA
12	9378895	OTHER	RI	GUARDIAN
13	050513332	OTHER	RI	CCN
14	103959900	OTHER	RI	DLWC
15	AA1566	OTHER	RI	PILGRIM

General Provider Information

NPI Number	:	1568458644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY T MOORADIAN DPT

Provider Business Mailing Address
First Line	:	12 BEACON HILL DR
Second Line	:
City	:	WATERFORD
State	:	CT
Zip	:	06385-4108
Country	:	US
Telephone Number	:	860-910-9571
Fax Number	:

Provider Business Practice Location Address
First Line	:	1666 ROUTE 12
Second Line	:
City	:	GALES FERRY
State	:	CT
Zip	:	06335-1541
Country	:	US
Telephone Number	:	860-941-9126
Fax Number	:

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	12/16/2021

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