Healthcare Provider Details

I. General information

NPI: 1972777027
Provider Name (Legal Business Name): RAMIL MORADOS ABENALES P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2008
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S SOUTH ST SUITE 100
MOUNT AIRY NC
27030-4450
US

IV. Provider business mailing address

872 WILLOW HILL CIR
MOUNT AIRY NC
27030-2744
US

V. Phone/Fax

Practice location:
  • Phone: 336-789-4094
  • Fax:
Mailing address:
  • Phone: 919-413-4387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11568
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: