Healthcare Provider Details

I. General information

NPI: 1548679723
Provider Name (Legal Business Name): ANTHONY MORINA RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9441 LBJ FWY SUITE 602
DALLAS TX
75243-4545
US

IV. Provider business mailing address

4330 S 41ST ST APT 23
TACOMA WA
98409-2109
US

V. Phone/Fax

Practice location:
  • Phone: 866-474-6677
  • Fax:
Mailing address:
  • Phone: 602-320-4916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberLR 60305039
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberLR 60305039
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License NumberLR 60305039
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: