Provider Demographics
NPI:1568458644
Name:MOORADIAN, AMY T (DPT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:T
Last Name:MOORADIAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:T
Other - Last Name:MEDEIROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:12 BEACON HILL DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4108
Mailing Address - Country:US
Mailing Address - Phone:860-910-9571
Mailing Address - Fax:
Practice Address - Street 1:1666 ROUTE 12
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1541
Practice Address - Country:US
Practice Address - Phone:860-941-9126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009106225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI050513332OtherGREATWEST
RIP00322419OtherMEDICARE RAILROAD
RI050513332OtherCHAMPUS
RI103959900OtherUSDE
RI26848OtherBLUE CROSS BLUE SHIELD RI
RI5669517OtherCOVENTRY HEALTH FIRST HEA
RI9378895OtherPHCS
RI268480OtherBLUE CROSS PROVIDER NUMBE
RI050513332OtherUNITED HEALTHCARE
RI411015OtherBLUE CHIP RI
RI779850OtherAETNA
RI9378895OtherGUARDIAN
RI050513332OtherCCN
RI103959900OtherDLWC
RIAA1566OtherPILGRIM