MEDICARE: DR. MARIANA DANIELA MOISE 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	028911-1	NY
2	225100000X	Physical Therapist	070.019485	IL

General Provider Information

NPI Number	:	1912030941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANA DANIELA MOISE DPT

Provider Business Mailing Address
First Line	:	2500 WINDSOR MALL APT 3E
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-3639
Country	:	US
Telephone Number	:	646-400-4764
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 WINDSOR MALL APT 3E
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-3639
Country	:	US
Telephone Number	:	646-400-4764
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	01/15/2020

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