Provider Demographics
NPI:1679669758
Name:MORALES, MARIE CHRISTINE (PT)
Entity Type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:CHRISTINE
Last Name:MORALES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 BAYSHORE HWY
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1602
Mailing Address - Country:US
Mailing Address - Phone:650-692-5633
Mailing Address - Fax:650-692-8497
Practice Address - Street 1:1545 BAYSHORE HWY
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1602
Practice Address - Country:US
Practice Address - Phone:650-692-5633
Practice Address - Fax:650-692-8497
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT286280Medicare PIN