Provider Demographics
NPI:1427567890
Name:MOREAU, MONA (OTR)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:MOREAU
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12368 NW 54TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3410
Mailing Address - Country:US
Mailing Address - Phone:954-531-4737
Mailing Address - Fax:
Practice Address - Street 1:3275 W HILLSBORO BLVD STE 210
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9476
Practice Address - Country:US
Practice Address - Phone:954-428-4707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11479208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation