Provider Demographics
NPI:1518386754
Name:MORAN, AMY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 INDIAN LAKE BLVD APT J204
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6329
Mailing Address - Country:US
Mailing Address - Phone:615-305-6385
Mailing Address - Fax:
Practice Address - Street 1:125 COOL SPRINGS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6474
Practice Address - Country:US
Practice Address - Phone:615-472-1711
Practice Address - Fax:615-472-1942
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer