Basic Information
| Provider Information | |||||||||
| NPI: | 1578802906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOERK | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | BETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601791 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369967001 | ||||||||
| FaxNumber: | 3369960832 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 GATEWAY CENTER DR | ||||||||
| Address2: | |||||||||
| City: | KERNERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272842999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369967001 | ||||||||
| FaxNumber: | 3369960832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2013 | ||||||||
| LastUpdateDate: | 02/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P2267 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.