Provider Demographics
NPI:1558074369
Name:MORAN, JORGE (DPT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:MORAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 E YEARGIN DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4143
Mailing Address - Country:US
Mailing Address - Phone:559-285-6081
Mailing Address - Fax:
Practice Address - Street 1:4080 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5267
Practice Address - Country:US
Practice Address - Phone:559-222-7497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist