Provider Demographics
NPI:1730314584
Name:MORIARTY, BRENDAN PATRICK (ATC)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:PATRICK
Last Name:MORIARTY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 PINE ST
Mailing Address - Street 2:
Mailing Address - City:WARRIOR RUN
Mailing Address - State:PA
Mailing Address - Zip Code:18706-1925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:407 PINE ST
Practice Address - Street 2:
Practice Address - City:WARRIOR RUN
Practice Address - State:PA
Practice Address - Zip Code:18706-1925
Practice Address - Country:US
Practice Address - Phone:570-706-6407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer