Provider Demographics
NPI:1871984690
Name:MORA, MAXIMO JR (PT)
Entity type:Individual
Prefix:DR
First Name:MAXIMO
Middle Name:
Last Name:MORA
Suffix:JR
Gender:M
Credentials:PT
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Mailing Address - Street 1:6818 AUSTIN CENTER BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3158
Mailing Address - Country:US
Mailing Address - Phone:512-418-8870
Mailing Address - Fax:512-418-1954
Practice Address - Street 1:6818 AUSTIN CENTER BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3158
Practice Address - Country:US
Practice Address - Phone:512-418-8870
Practice Address - Fax:512-418-1954
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1255646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist