Individual
MRS. TERA CONERLY MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
39336 OAKLYN DR, PONCHATOULA, LA 70454-7094
(985) 507-6349
Mailing address
39336 OAKLYN DR, PONCHATOULA, LA 70454-7094
(985) 507-6349
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
02657
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1479373
—
LA
Enumeration date
05/16/2011
Last updated
05/16/2011
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