Provider Demographics
NPI:1275031320
Name:DAY, MORIAH LYNN
Entity Type:Individual
Prefix:
First Name:MORIAH
Middle Name:LYNN
Last Name:DAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 JUNIPER AVE APT 52
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2483
Mailing Address - Country:US
Mailing Address - Phone:626-242-4390
Mailing Address - Fax:
Practice Address - Street 1:2749 IRIS AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2433
Practice Address - Country:US
Practice Address - Phone:626-242-4390
Practice Address - Fax:626-242-4390
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0020204204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine