Provider Demographics
NPI:1407453061
Name:MOOGERFELD, ERIC A (PT, DPT, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:MOOGERFELD
Suffix:
Gender:M
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19333 SW 68TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1650
Mailing Address - Country:US
Mailing Address - Phone:954-579-0498
Mailing Address - Fax:
Practice Address - Street 1:7857 N UNIVERSITY DR # 401
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33067-2600
Practice Address - Country:US
Practice Address - Phone:954-518-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL47272255A2300X
FLPT36312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer