Provider Demographics
NPI:1841737095
Name:VICTORIA MORAN PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:VICTORIA MORAN PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:516-528-3798
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-0244
Mailing Address - Country:US
Mailing Address - Phone:516-528-3798
Mailing Address - Fax:
Practice Address - Street 1:30 E 60TH ST STE 904
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1059
Practice Address - Country:US
Practice Address - Phone:516-528-3798
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030343261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy