Provider Demographics
NPI:1912030941
Name:MOISE, MARIANA DANIELA (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:DANIELA
Last Name:MOISE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:MARIANA
Other - Middle Name:DANIELA
Other - Last Name:PRUTICA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:2500 WINDSOR MALL APT 3E
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3639
Mailing Address - Country:US
Mailing Address - Phone:646-400-4764
Mailing Address - Fax:
Practice Address - Street 1:2500 WINDSOR MALL APT 3E
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3639
Practice Address - Country:US
Practice Address - Phone:646-400-4764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028911-1225100000X
IL070.019485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist