Provider Demographics
NPI:1750607172
Name:MORELAND, LAURIE L (DPT)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:L
Last Name:MORELAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20101 SW BIRCH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1749
Mailing Address - Country:US
Mailing Address - Phone:949-721-9400
Mailing Address - Fax:949-721-9470
Practice Address - Street 1:129 W. WILSON ST.
Practice Address - Street 2:SUITE 202
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-631-0125
Practice Address - Fax:949-631-0127
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist