Basic Information
Provider Information
NPI: 1346721065
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORALES
FirstName: ANNE
MiddleName: STUIFBERGEN
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12010 YARBROUGH DR
Address2:  
City: AUSTIN
State: TX
PostalCode: 787482061
CountryCode: US
TelephoneNumber: 5129646328
FaxNumber:  
Practice Location
Address1: 2101 FRATE BARKER RD
Address2:  
City: AUSTIN
State: TX
PostalCode: 787483614
CountryCode: US
TelephoneNumber: 5124445627
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/22/2018
LastUpdateDate: 08/22/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251G0304X1176159TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics

No ID Information.


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