Provider Demographics
NPI:1891760302
Name:MORALES, ALAN (MED, ATC/L)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:MED, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7911 BUCK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-7149
Mailing Address - Country:US
Mailing Address - Phone:850-273-1388
Mailing Address - Fax:
Practice Address - Street 1:7911 BUCK LAKE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-7149
Practice Address - Country:US
Practice Address - Phone:850-273-1388
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 1562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer