Provider Demographics
NPI:1083079560
Name:MORAN, JUDITH (RRT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 3RD AVE N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3261
Mailing Address - Country:US
Mailing Address - Phone:727-565-0360
Mailing Address - Fax:
Practice Address - Street 1:447 3RD AVE N
Practice Address - Street 2:SUITE 300
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3261
Practice Address - Country:US
Practice Address - Phone:727-565-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT5618227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRT5618OtherLICENSE