Provider Demographics
NPI:1568033637
Name:MORAN, MEAGHAN (DPT)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
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:PO BOX 2736
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91979-2736
Mailing Address - Country:US
Mailing Address - Phone:619-573-6373
Mailing Address - Fax:619-378-6578
Practice Address - Street 1:860 JAMACHA RD STE 203
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3224
Practice Address - Country:US
Practice Address - Phone:619-573-6373
Practice Address - Fax:619-378-6578
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3003492251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic