Provider Demographics
NPI:1053360222
Name:MORIARTY, JEFFREY (PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:MORIARTY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 S CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5073
Mailing Address - Country:US
Mailing Address - Phone:303-680-6121
Mailing Address - Fax:303-680-8627
Practice Address - Street 1:3451 S CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5073
Practice Address - Country:US
Practice Address - Phone:303-680-6121
Practice Address - Fax:303-680-8627
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7874174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist