Provider Demographics
NPI:1932916616
Name:MORAN, LYDIA TAYLOR (DPT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:TAYLOR
Last Name:MORAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MIDDLETOWN CMNS STE 260
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8949
Mailing Address - Country:US
Mailing Address - Phone:304-816-3169
Mailing Address - Fax:
Practice Address - Street 1:2600 MIDDLETOWN CMNS STE 260
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8949
Practice Address - Country:US
Practice Address - Phone:304-816-3169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist