Healthcare Provider Details

I. General information

NPI: 1548325038
Provider Name (Legal Business Name): CELVYN MORADA PT, DPT, CKTP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 E 84TH ST 2ND FLOOR
NEW YORK NY
10028-2000
US

IV. Provider business mailing address

171 E 84TH ST 2ND FLOOR
NEW YORK NY
10028-2000
US

V. Phone/Fax

Practice location:
  • Phone: 212-327-0600
  • Fax: 212-327-0776
Mailing address:
  • Phone: 212-327-0600
  • Fax: 212-327-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62032601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: