Provider Demographics
NPI:1275712788
Name:MOREAU, STEVEN T (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:T
Last Name:MOREAU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2318 COUNTY ROAD 39
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14469-9507
Mailing Address - Country:US
Mailing Address - Phone:585-657-7089
Mailing Address - Fax:
Practice Address - Street 1:260 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2432
Practice Address - Country:US
Practice Address - Phone:207-879-7510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT12522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic