Provider Demographics
NPI:1174837066
Name:MORENO, MANUEL F (MA)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:F
Last Name:MORENO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 SW 8TH ST STE 21
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2968
Mailing Address - Country:US
Mailing Address - Phone:305-804-1719
Mailing Address - Fax:
Practice Address - Street 1:9600 SW 8TH ST STE 21
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2968
Practice Address - Country:US
Practice Address - Phone:305-804-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42951261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy