Provider Demographics
NPI:1093168940
Name:WANDA RIOS MORALES
Entity Type:Organization
Organization Name:WANDA RIOS MORALES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:RIOS MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:407-968-3442
Mailing Address - Street 1:803 SPRUCEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-9619
Mailing Address - Country:US
Mailing Address - Phone:407-968-3442
Mailing Address - Fax:
Practice Address - Street 1:2275 FORTUNE RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4404
Practice Address - Country:US
Practice Address - Phone:407-348-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA25800261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center