Provider Demographics
NPI:1548325038
Name:MORADA, CELVYN (PT, DPT, CKTP)
Entity type:Individual
Prefix:MR
First Name:CELVYN
Middle Name:
Last Name:MORADA
Suffix:
Gender:M
Credentials:PT, DPT, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 E 84TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2000
Mailing Address - Country:US
Mailing Address - Phone:212-327-0600
Mailing Address - Fax:212-327-0776
Practice Address - Street 1:171 E 84TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2000
Practice Address - Country:US
Practice Address - Phone:212-327-0600
Practice Address - Fax:212-327-0776
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62032601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist