1780070300 NPI number — CAROLYN NICOLE MORALES MSPT, DPT

Table of content: CAROLYN NICOLE MORALES MSPT, DPT (NPI 1780070300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780070300 NPI number — CAROLYN NICOLE MORALES MSPT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORALES
Provider First Name:
CAROLYN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSPT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780070300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
821 CALLE YCARO
Provider Second Line Business Mailing Address:
ALTURAS DEL PARQUE ECUESTRE
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00987-8597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-447-8798
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 CALLE YCARO
Provider Second Line Business Practice Location Address:
ALTURAS DEL PARQUE ECUESTRE
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00987-8597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-447-8798
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  001451 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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