Provider Demographics
NPI:1700438116
Name:MORAN, CONNOR R (DPT)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:R
Last Name:MORAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 WINDWARD WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7709
Mailing Address - Country:US
Mailing Address - Phone:614-563-4710
Mailing Address - Fax:
Practice Address - Street 1:25285 MADISON AVE STE 103
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8955
Practice Address - Country:US
Practice Address - Phone:951-600-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCP008751T225100000X
OHPT017968225100000X
CAPT303606225100000X
KY007689225100000X
COPTL0019745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist