Provider Demographics
NPI:1487483624
Name:MORADO, KRISE P (PTA)
Entity type:Individual
Prefix:
First Name:KRISE
Middle Name:P
Last Name:MORADO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KRISELDA
Other - Middle Name:V
Other - Last Name:PINEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:2205 SALINAS AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-2318
Mailing Address - Country:US
Mailing Address - Phone:432-895-4581
Mailing Address - Fax:
Practice Address - Street 1:111 PARKS VILLAGE DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8987
Practice Address - Country:US
Practice Address - Phone:432-563-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2108201208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation