Provider Demographics
NPI:1649299165
Name:MORALES, ANITA ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:ELIZABETH
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 1:4305 CALLAHAN RD
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-7228
Mailing Address - Country:US
Mailing Address - Phone:432-264-0605
Mailing Address - Fax:
Practice Address - Street 1:300 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5500
Practice Address - Country:US
Practice Address - Phone:432-263-7361
Practice Address - Fax:432-268-5048
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist