Provider Demographics
NPI:1770874521
Name:MORAN, AMY (CCMP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:CCMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 19TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-1765
Mailing Address - Country:US
Mailing Address - Phone:916-775-3766
Mailing Address - Fax:
Practice Address - Street 1:2020 U ST STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1768
Practice Address - Country:US
Practice Address - Phone:916-775-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17268225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist