Active NPI
Al C Moreau III, PT
- Physical Therapist
- Zachary, LA
National Provider Identifier
1124019344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 04423
- Practice address
- 2335 Church St
Ste G
Zachary, LA 70791-2700 - Phone
- (225) 654-8208
- Fax
- (225) 654-4642
- NPI assigned
- Nov 4, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 04423 | LA | Primary |
Addresses
Primary practice location
2335 Church St
Ste G
Zachary, LA 70791-2700
Mailing address
2335 Church St
Ste G
Zachary, LA 70791-2700
Phone (225) 654-8208
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1022641 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04423 | LA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200096000000",
"number": "1124019344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2335 CHURCH ST",
"address_2": "STE G",
"city": "ZACHARY",
"state": "LA",
"postal_code": "707912700",
"telephone_number": "225-654-8208",
"fax_number": "225-654-4642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2335 CHURCH ST",
"address_2": "STE G",
"city": "ZACHARY",
"state": "LA",
"postal_code": "707912700",
"telephone_number": "225-654-8208",
"fax_number": "225-654-4642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOREAU",
"first_name": "AL",
"middle_name": "C",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-04",
"last_updated": "2008-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "04423",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1022641",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Zachary, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.