Provider Demographics
NPI:1831860998
Name:MOREAU, MARIE (LMT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MOREAU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4630 S KIRKMAN RD # 157
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2833
Mailing Address - Country:US
Mailing Address - Phone:407-815-5344
Mailing Address - Fax:
Practice Address - Street 1:4864 CYPRESS WOODS DR APT 305
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-3508
Practice Address - Country:US
Practice Address - Phone:407-815-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA77952225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist