Provider Demographics
NPI:1013337062
Name:MORALES, LORENZO LUIS (MS, PTA, ATC-L)
Entity Type:Individual
Prefix:MR
First Name:LORENZO
Middle Name:LUIS
Last Name:MORALES
Suffix:
Gender:M
Credentials:MS, PTA, ATC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 REGAL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-0060
Mailing Address - Country:US
Mailing Address - Phone:704-307-8948
Mailing Address - Fax:
Practice Address - Street 1:3155 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3903
Practice Address - Country:US
Practice Address - Phone:336-718-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19332255A2300X
NCA7381225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer