Provider Demographics
NPI:1588081061
Name:MORALETA, LAUDENICIA RAMIREZ (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:LAUDENICIA
Middle Name:RAMIREZ
Last Name:MORALETA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PETERSEN PL
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2019
Mailing Address - Country:US
Mailing Address - Phone:201-486-3541
Mailing Address - Fax:201-783-8236
Practice Address - Street 1:70 PETERSEN PL
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-2019
Practice Address - Country:US
Practice Address - Phone:201-486-3541
Practice Address - Fax:201-783-8236
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist