Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT009317 | GA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT012812L | PA |
NPI | 1043461650 |
---|---|
Provider Name | Alexandra Moran |
First Address | Decatur, GA 30030-1644 |
Second Address | Decatur, GA 30030-1644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 02/10/2008 |