Provider Demographics
NPI:1386693612
Name:MORASCO, MICHAEL KEITH (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KEITH
Last Name:MORASCO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2958 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-7402
Mailing Address - Country:US
Mailing Address - Phone:760-294-9585
Mailing Address - Fax:951-506-3002
Practice Address - Street 1:215 S HICKORY ST
Practice Address - Street 2:STE. 112
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4359
Practice Address - Country:US
Practice Address - Phone:760-737-8460
Practice Address - Fax:760-739-5669
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 11458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA208500Medicare PIN
CACB260574Medicare PIN
CAWPT11458AMedicare PIN
CAWPT11458BMedicare PIN