Provider Demographics
NPI:1790126175
Name:MORALES, CYNTHIA JANNETT (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JANNETT
Last Name:MORALES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 DIETZ RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1132
Mailing Address - Country:US
Mailing Address - Phone:617-335-2116
Mailing Address - Fax:
Practice Address - Street 1:4593 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4844
Practice Address - Country:US
Practice Address - Phone:617-327-9097
Practice Address - Fax:617-327-4307
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7921225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant