Renee Marie Moran, P.T.
Individual provider Active NPI Physical Therapist · Bangor, ME
NPI 1154583391 · NPPES record last updated Jan 31, 2024
Key facts
- NPI
- 1154583391
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT2729 (ME)
- Practice address
- 43 Bangor Mall Blvd Unit D-1
Bangor, ME 04401-3612 - Phone
- (207) 291-5714
- Fax
- (207) 433-1246
- NPI assigned
- Jun 30, 2008
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Beane Family Ventures Inc.
Practice addresses (Care Compare)
31 Bangor Mall Blvd
Bangor, ME 04401-3612
Phone (207) 291-5714
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240711003322 | ME | Practitioner - Physical Therapist in Private Practice | 0244775427 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT2729 | ME | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beane Family Ventures Inc. | Current |
Accepting new patients | |
| Beane Family Ventures Inc. | Physical Therapist | Current |
Accepting new patients |
Locations
31 Bangor Mall Blvd
Bangor, ME 04401
Phone (207) 291-5714
43 Bangor Mall Blvd
Unit D1
Bangor, ME 04401
Phone (207) 291-5714
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT2729 | ME | Yes |
Addresses
Primary practice location
43 Bangor Mall Blvd Unit D-1
Bangor, ME 04401-3612
Mailing address
22 Allison Park
Brewer, ME 04412-1350
Phone (207) 989-0608
Other practice location 1
22 Allison Park
Brewer, ME 04412-1350
Phone (207) 989-0608
Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.