Provider Demographics
NPI:1154367688
Name:MORAN, MARGUERITE MARY (PT)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:MARY
Last Name:MORAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LENNOX RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2808
Mailing Address - Country:US
Mailing Address - Phone:330-656-3244
Mailing Address - Fax:
Practice Address - Street 1:24 LENNOX RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2808
Practice Address - Country:US
Practice Address - Phone:330-656-3244
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.T. 001841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist