Provider Demographics
NPI:1568942399
Name:MOURYA, SIDDHARTH
Entity Type:Individual
Prefix:
First Name:SIDDHARTH
Middle Name:
Last Name:MOURYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 FALLIN BLVD APT B1
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4367
Mailing Address - Country:US
Mailing Address - Phone:909-654-8891
Mailing Address - Fax:
Practice Address - Street 1:RIVER POINT CREST NURSING AND REHABILITATION
Practice Address - Street 2:2600 OLD CHERRY POINT ROAD
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560
Practice Address - Country:US
Practice Address - Phone:252-672-5034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist