Provider Demographics
NPI:1104805910
Name:MOREAU, MICHAEL D (MSPT CERT MDT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:MOREAU
Suffix:
Gender:M
Credentials:MSPT CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 N CENTER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2796
Mailing Address - Country:US
Mailing Address - Phone:828-322-7007
Mailing Address - Fax:828-327-6006
Practice Address - Street 1:1344 N CENTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2796
Practice Address - Country:US
Practice Address - Phone:828-322-7007
Practice Address - Fax:828-327-6006
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA5929OtherMEDCOST
NC806058OtherPARTNERS MEDICARE
NC5759083OtherAETNA
NC078EROtherBCBS
NCA5929OtherMEDCOST