Provider Demographics
NPI:1134492770
Name:MORALES, ROSELIN M (LMT)
Entity Type:Individual
Prefix:
First Name:ROSELIN
Middle Name:M
Last Name:MORALES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1179 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-2007
Mailing Address - Country:US
Mailing Address - Phone:484-597-0904
Mailing Address - Fax:
Practice Address - Street 1:1179 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-2007
Practice Address - Country:US
Practice Address - Phone:484-597-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004255173C00000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
No173C00000XOther Service ProvidersReflexologist