Provider Demographics
NPI:1720715659
Name:MORENO, BRITTANY SHAWN (PT DPT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:SHAWN
Last Name:MORENO
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14800 99TH AVE N APT 229
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7581
Mailing Address - Country:US
Mailing Address - Phone:651-485-6701
Mailing Address - Fax:
Practice Address - Street 1:15301 GROVE CIR N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4475
Practice Address - Country:US
Practice Address - Phone:952-993-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN126232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic