Provider Demographics
NPI:1831938646
Name:MORENO, ERICA NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:NICOLE
Last Name:MORENO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 C M FAGAN DR STE 103
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5963
Mailing Address - Country:US
Mailing Address - Phone:985-542-6664
Mailing Address - Fax:985-542-6428
Practice Address - Street 1:1100 C M FAGAN DR STE 103
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5963
Practice Address - Country:US
Practice Address - Phone:985-542-6664
Practice Address - Fax:985-542-6428
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist