Provider Demographics
NPI:1164144515
Name:MOORER, LOREN (PT)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:MOORER
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 1:900 CIRCLE 75 PKWY SE STE 1700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3087
Mailing Address - Country:US
Mailing Address - Phone:678-996-7230
Mailing Address - Fax:
Practice Address - Street 1:2976 CHAPEL HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1849
Practice Address - Country:US
Practice Address - Phone:770-949-8558
Practice Address - Fax:770-949-6966
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT016254OtherLICENSE