Active NPI
Richard Moreno Jr.
- Physical Therapy Assistant
- Glendale, AZ
National Provider Identifier
1649667635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 11463A
- Practice address
- 6509 W Acapulco LN
Glendale, AZ 85306 - Phone
- (602) 421-8231
- NPI assigned
- Apr 17, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 11463A | AZ | Primary |
Addresses
Primary practice location
6509 W Acapulco LN
Glendale, AZ 85306
Mailing address
6509 W Acapulco LN
Glendale, AZ 85306
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11463A | AZ | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429228800000",
"number": "1649667635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6509 W ACAPULCO LN",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "85306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6509 W ACAPULCO LN",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "85306",
"telephone_number": "602-421-8231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "RICHARD",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-17",
"last_updated": "2015-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AZ",
"license": "11463A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.