Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1216295 | TX |
NPI | 1073867156 |
---|---|
Provider Name | Luisa Fernanda Moreno |
First Address | Houston, TX 77077-6161 |
Second Address | Houston, TX 77063-5277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2012 |
Last Update Date | 29/10/2012 |