Provider Demographics
NPI:1639303563
Name:MORAN, LEAH
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CONEY ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:UNION MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28167-8567
Mailing Address - Country:US
Mailing Address - Phone:828-289-6209
Mailing Address - Fax:
Practice Address - Street 1:211 CONEY ISLAND RD
Practice Address - Street 2:
Practice Address - City:UNION MILLS
Practice Address - State:NC
Practice Address - Zip Code:28167-8567
Practice Address - Country:US
Practice Address - Phone:828-289-6209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3086225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant