Provider Demographics
NPI:1407818982
Name:MORELAND, MICHAEL ROBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:MORELAND
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 1:8838 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-4822
Mailing Address - Country:US
Mailing Address - Phone:919-550-7722
Mailing Address - Fax:919-550-7742
Practice Address - Street 1:8838 US HIGHWAY 70 W
Practice Address - Street 2:SUITE 300
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-4822
Practice Address - Country:US
Practice Address - Phone:919-550-7722
Practice Address - Fax:919-550-7742
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079P3OtherBLUE CROSS BLUE SHIELD
NC079P3OtherBLUE CROSS BLUE SHIELD