Provider Demographics
NPI:1003686361
Name:MORA, FELIX ELIZAGA JR (LMT, NMT)
Entity Type:Individual
Prefix:MR
First Name:FELIX
Middle Name:ELIZAGA
Last Name:MORA
Suffix:JR
Gender:M
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 PORTSDALE DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1548
Mailing Address - Country:US
Mailing Address - Phone:310-404-1003
Mailing Address - Fax:
Practice Address - Street 1:468 PORTSDALE DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1548
Practice Address - Country:US
Practice Address - Phone:310-404-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12845225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist