MEDICARE: MORGAN STRATE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer
2	225100000X	Physical Therapist	PT-2024-0104	NM

General Provider Information

NPI Number	:	1134676752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN STRATE DPT

Provider Business Mailing Address
First Line	:	18881 W DODGE RD STE 300W
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-4648
Country	:	US
Telephone Number	:	877-230-3885
Fax Number	:	402-925-4425

Provider Business Practice Location Address
First Line	:	5616 S STATE ROUTE 1
Second Line	:
City	:	SAINT ANNE
State	:	IL
Zip	:	60964-5264
Country	:	US
Telephone Number	:	815-922-5101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	04/15/2024

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