Provider Demographics
NPI:1801625728
Name:MORA MORA, GRACIELA MARIA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:MARIA
Last Name:MORA MORA
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LARK LN
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7017
Mailing Address - Country:US
Mailing Address - Phone:973-931-0796
Mailing Address - Fax:
Practice Address - Street 1:15 LARK LN
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7017
Practice Address - Country:US
Practice Address - Phone:973-931-0796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01214700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist