Provider Demographics
NPI:1205863081
Name:LOCIGNO, MOIRA D (PT)
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:D
Last Name:LOCIGNO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MOIRA
Other - Middle Name:
Other - Last Name:DORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:STE 460
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-391-5515
Mailing Address - Fax:561-347-7470
Practice Address - Street 1:660 GLADES RD
Practice Address - Street 2:STE 460
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-391-5515
Practice Address - Fax:561-347-7470
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK952ZMedicare UPIN