Provider Demographics
NPI:1619227477
Name:MORALES, CRISTINA J (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:J
Last Name:MORALES
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46325 W 12 MILE RD
Practice Address - Street 2:STE 125
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2456
Practice Address - Country:US
Practice Address - Phone:248-869-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019359225100000X
MI5501016347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP01438556OtherRR MEDICARE
MIMI6211125Medicare PIN