Provider Demographics
NPI:1326563735
Name:MORAN, GINA MARIE MARTORANA (DPT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE MARTORANA
Last Name:MORAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7621 AUSTIN BLUFFS PKWY UNIT 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-2904
Mailing Address - Country:US
Mailing Address - Phone:719-596-5000
Mailing Address - Fax:
Practice Address - Street 1:7621 AUSTIN BLUFFS PKWY UNIT 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-2904
Practice Address - Country:US
Practice Address - Phone:719-596-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist