Provider Demographics
NPI:1871609826
Name:MORAN, REBECCA PEERY (PT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:PEERY
Last Name:MORAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 WARM SPRINGS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5323
Mailing Address - Country:US
Mailing Address - Phone:706-243-0016
Mailing Address - Fax:706-243-0019
Practice Address - Street 1:2616 WARM SPRINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5323
Practice Address - Country:US
Practice Address - Phone:706-243-0016
Practice Address - Fax:706-243-0019
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA968010OtherBCBS
GAP00401108OtherMEDICARE RAILROAD
GAP00401108OtherMEDICARE RAILROAD
GA$$$$$$$$$OtherTRICARE