Provider Demographics
NPI:1871230326
Name:MORALES, JESSICA CHRISTINE CORTEZ (PT)
Entity Type:Individual
Prefix:
First Name:JESSICA CHRISTINE
Middle Name:CORTEZ
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 1:6916 WALNUT CREEK RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2834
Mailing Address - Country:US
Mailing Address - Phone:765-702-5504
Mailing Address - Fax:
Practice Address - Street 1:PINON HEALTH CENTER
Practice Address - Street 2:NAVAJO SERVICE RTE 41
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-725-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist