Provider Demographics
NPI:1255964722
Name:MORALES, RAYMOND BENITO (PT)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:BENITO
Last Name:MORALES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2001
Mailing Address - Country:US
Mailing Address - Phone:301-942-2500
Mailing Address - Fax:
Practice Address - Street 1:11901 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-2001
Practice Address - Country:US
Practice Address - Phone:301-942-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD23040OtherMARYLAND BOARD OF PHYSICAL THERAPY