Provider Demographics
NPI:1396949723
Name:MORAN, ELLEN MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MARIE
Last Name:MORAN
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 1:14101 SHAWHAN PL
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3306
Mailing Address - Country:US
Mailing Address - Phone:804-594-7239
Mailing Address - Fax:
Practice Address - Street 1:7090 COVENANT WOODS DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-7025
Practice Address - Country:US
Practice Address - Phone:804-559-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist