Provider Demographics
NPI:1124209606
Name:MORELAND, MONICA (PT)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MORELAND
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 1:2225 N MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-3365
Mailing Address - Country:US
Mailing Address - Phone:775-359-1199
Mailing Address - Fax:775-359-1195
Practice Address - Street 1:2225 N MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-3365
Practice Address - Country:US
Practice Address - Phone:775-359-1199
Practice Address - Fax:775-359-1195
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00032540OtherRAILROAD MEDICARE PIN
NVV37492Medicare PIN