Provider Demographics
NPI:1598390809
Name:MOORMAN, BRIANA JO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:JO
Last Name:MOORMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 ABBEY CHASE CT
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7457
Mailing Address - Country:US
Mailing Address - Phone:614-460-0312
Mailing Address - Fax:
Practice Address - Street 1:719 N MARION ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1530
Practice Address - Country:US
Practice Address - Phone:312-401-0975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2023-05-11
Deactivation Date:2022-12-08
Deactivation Code:
Reactivation Date:2023-05-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist