Provider Demographics
NPI:1083393375
Name:MORAN, ROBERTA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:ROBERTA
Other - Middle Name:
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:626 E RYAN ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5056
Mailing Address - Country:US
Mailing Address - Phone:956-206-5232
Mailing Address - Fax:
Practice Address - Street 1:414 SHILOH DR UNIT 9
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6745
Practice Address - Country:US
Practice Address - Phone:956-791-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2027514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist