Provider Demographics
NPI:1518291103
Name:MOREIRA, JEFFREY (MSPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:MOREIRA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FEDERAL RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2556
Mailing Address - Country:US
Mailing Address - Phone:203-546-8648
Mailing Address - Fax:888-558-7910
Practice Address - Street 1:195 FEDERAL RD
Practice Address - Street 2:SUITE 6
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2556
Practice Address - Country:US
Practice Address - Phone:203-546-8648
Practice Address - Fax:888-558-7910
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist