Provider Demographics
NPI:1689633737
Name:MORAN, CHRISTINE A (MS PT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:A
Last Name:MORAN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71076
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23255-1076
Mailing Address - Country:US
Mailing Address - Phone:804-839-0164
Mailing Address - Fax:866-816-9721
Practice Address - Street 1:1601 ROLLING HILLS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5011
Practice Address - Country:US
Practice Address - Phone:804-839-0164
Practice Address - Fax:866-816-9721
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305001100225100000X
VA91050000042251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190002007Medicare PIN