1588892129 NPI number — MRS. MARY CAROL MORELAN PT, ATP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588892129 NPI number — MRS. MARY CAROL MORELAN PT, ATP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORELAN
Provider First Name:
MARY
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT, ATP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESTRADA
Provider Other First Name:
MARY
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588892129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 RACQUET CLUB CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76017-3717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-472-6201
Provider Business Mailing Address Fax Number:
817-987-0810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2202 RACQUET CLUB CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76017-3717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-472-6201
Provider Business Practice Location Address Fax Number:
817-987-0810
Provider Enumeration Date:
06/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1090603 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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