Provider Demographics
NPI:1255370821
Name:MORETTO, MARY COLLEEN (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:COLLEEN
Last Name:MORETTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5301
Mailing Address - Country:US
Mailing Address - Phone:845-562-1054
Mailing Address - Fax:845-562-6148
Practice Address - Street 1:333 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5301
Practice Address - Country:US
Practice Address - Phone:845-562-1054
Practice Address - Fax:845-562-6148
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ17F51Medicare ID - Type Unspecified