Provider Demographics
NPI:1528276706
Name:MORAN, KATHRYN M (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:MORAN
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1930
Mailing Address - Country:US
Mailing Address - Phone:914-747-1059
Mailing Address - Fax:
Practice Address - Street 1:185 MAPLE AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4776
Practice Address - Country:US
Practice Address - Phone:914-997-6970
Practice Address - Fax:914-946-4619
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006115246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other