Provider Demographics
NPI:1144237850
Name:MORIARTY, SUZANNE BARNEY (PTA)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BARNEY
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5336 WHITTEN DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-5301
Mailing Address - Country:US
Mailing Address - Phone:239-261-1915
Mailing Address - Fax:
Practice Address - Street 1:1725 HERITAGE TRL
Practice Address - Street 2:SUITE 301
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-8716
Practice Address - Country:US
Practice Address - Phone:239-649-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA16919225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant