Provider Demographics
NPI:1407285562
Name:MORICONE, PHILIP THOMAS IV (DPT)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:THOMAS
Last Name:MORICONE
Suffix:IV
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:PHIL
Other - Middle Name:
Other - Last Name:MORICONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:7264 E VILLANUEVA DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6441
Mailing Address - Country:US
Mailing Address - Phone:603-475-4128
Mailing Address - Fax:
Practice Address - Street 1:7264 E VILLANUEVA DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-6441
Practice Address - Country:US
Practice Address - Phone:603-475-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist