Provider Demographics
NPI:1902868003
Name:MORALES, ESEQUIEL (MPT)
Entity Type:Individual
Prefix:MR
First Name:ESEQUIEL
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:MR
Other - First Name:ZEKE
Other - Middle Name:
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPT
Mailing Address - Street 1:439 MECHEM DR
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6813
Mailing Address - Country:US
Mailing Address - Phone:575-257-1800
Mailing Address - Fax:575-257-2319
Practice Address - Street 1:439 MECHEM DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6813
Practice Address - Country:US
Practice Address - Phone:575-257-1800
Practice Address - Fax:575-257-2319
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM53106750Medicaid
NM53106750Medicaid