Provider Demographics
NPI:1639189491
Name:MORALES, GUILLERMO (PT)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 INTERSTATE 20 W
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1677
Mailing Address - Country:US
Mailing Address - Phone:817-466-7276
Mailing Address - Fax:817-466-7286
Practice Address - Street 1:2310 INTERSTATE 20 W
Practice Address - Street 2:SUITE 204
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1677
Practice Address - Country:US
Practice Address - Phone:817-466-7276
Practice Address - Fax:817-466-7286
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10840282251X0800X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4086OtherBCBS
TX8D3796Medicare ID - Type Unspecified