Provider Demographics
NPI:1578742417
Name:MORAES, VERA LUCIA (PT)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:LUCIA
Last Name:MORAES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2328
Mailing Address - Country:US
Mailing Address - Phone:978-223-9900
Mailing Address - Fax:978-334-0067
Practice Address - Street 1:32 HOSPITAL HILL RD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2302
Practice Address - Country:US
Practice Address - Phone:978-632-5477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17929225100000X
NY019316-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist