Provider Demographics
NPI:1558329714
Name:MORANTE, ERIC L (PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:MORANTE
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 1:3196 ARBOR RDG
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4075
Mailing Address - Country:US
Mailing Address - Phone:404-667-5001
Mailing Address - Fax:
Practice Address - Street 1:2000 MIRROR LAKE BLVD
Practice Address - Street 2:SUITE S
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-2124
Practice Address - Country:US
Practice Address - Phone:770-456-7877
Practice Address - Fax:770-456-7880
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBFFMMedicare Oscar/Certification