Provider Demographics
NPI:1093828360
Name:MORAN, JAMES (MPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MORAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BIRNIE AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1107
Mailing Address - Country:US
Mailing Address - Phone:413-785-4666
Mailing Address - Fax:413-846-4756
Practice Address - Street 1:275 BICENTENNIAL HWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1900
Practice Address - Country:US
Practice Address - Phone:413-785-4666
Practice Address - Fax:413-846-4756
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL15993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69480Medicare ID - Type UnspecifiedMEDICARE