Provider Demographics
NPI:1821377839
Name:MORALES, JUAN ANTONIO (PTA , LMT)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:MORALES
Suffix:
Gender:M
Credentials:PTA , LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6595 SW 152ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2145
Mailing Address - Country:US
Mailing Address - Phone:786-355-5306
Mailing Address - Fax:
Practice Address - Street 1:6595 SW 152ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2145
Practice Address - Country:US
Practice Address - Phone:786-355-5306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26031225100000X
FLMA44895225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist