Healthcare Provider Details

I. General information

NPI: 1346721065
Provider Name (Legal Business Name): ANNE STUIFBERGEN MORALES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FRATE BARKER RD
AUSTIN TX
78748-3614
US

IV. Provider business mailing address

12010 YARBROUGH DR
AUSTIN TX
78748-2061
US

V. Phone/Fax

Practice location:
  • Phone: 512-444-5627
  • Fax:
Mailing address:
  • Phone: 512-964-6328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1176159
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: