Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 4956 | CT |
N | 2251G0304X | Physical Therapist - Geriatrics | 4956 | CT |
N | 2251H1200X | Hand | 4956 | CT |
N | 2251P0200X | Physical Therapist - Pediatrics | 4956 | CT |
N | 2251S0007X | Physical Therapist - Sports | 4956 | CT |
N | 2251X0800X | Physical Therapist - Orthopedic | 4956 | CT |
NPI | 1053455337 |
---|---|
Provider Name | Mrs. Maria I Moreno |
First Address | Middletown, CT 06457-4780 |
Second Address | Middletown, CT 06457-4780 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 06/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004175114 | (05) | CT |
080004956CT03 | ANTHEM BCBS (01) | CT |
114175114-00 | BLUE CARE FAMILY PLAN (01) | CT |
3372505 | AETNA (01) | CT |
64-04254 | UNITED HEALTHCARE (01) | CT |
712712 | CONNECTICARE (01) | CT |
A667399 | OXFORD (01) | CT |
OV1691 | HEALTHNET (01) | CT |