Provider Demographics
NPI:1801676069
Name:MORALES GOMEZ, EDLINE MARIE (PT, DPT, MPH)
Entity type:Individual
Prefix:
First Name:EDLINE
Middle Name:MARIE
Last Name:MORALES GOMEZ
Suffix:
Gender:F
Credentials:PT, DPT, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1242
Mailing Address - Street 2:
Mailing Address - City:ARROYO
Mailing Address - State:PR
Mailing Address - Zip Code:00714-1242
Mailing Address - Country:US
Mailing Address - Phone:787-525-5638
Mailing Address - Fax:
Practice Address - Street 1:931 AVE TITO CASTRO CARR. 14, BO. MACHUELO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4717
Practice Address - Country:US
Practice Address - Phone:787-765-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist