Provider Demographics
NPI:1003816455
Name:MORAN, SHERYL SAMMARCO (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:SAMMARCO
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 1:42762 EVENING BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-3616
Mailing Address - Country:US
Mailing Address - Phone:703-858-7660
Mailing Address - Fax:
Practice Address - Street 1:20098 ASHBROOK PL
Practice Address - Street 2:SUITE 190
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3393
Practice Address - Country:US
Practice Address - Phone:703-723-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007447A55Medicare ID - Type Unspecified