Provider Demographics
NPI:1043461650
Name:MORAN, ALEXANDRA (MPT)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 SYCAMORE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1644
Mailing Address - Country:US
Mailing Address - Phone:404-299-6060
Mailing Address - Fax:404-299-6383
Practice Address - Street 1:1014 SYCAMORE DR
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1644
Practice Address - Country:US
Practice Address - Phone:404-299-6060
Practice Address - Fax:404-299-6383
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0093172251X0800X
PAPT012812L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic