MEDICARE: MORGAN STEIN 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1659043321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORGAN STEIN DPT

Provider Business Mailing Address
First Line	:	314 5TH ST
Second Line	:
City	:	CARROLLTON
State	:	IL
Zip	:	62016-1325
Country	:	US
Telephone Number	:	217-324-8780
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 5TH ST
Second Line	:
City	:	CARROLLTON
State	:	IL
Zip	:	62016-1325
Country	:	US
Telephone Number	:	217-324-8780
Fax Number	:

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

Provider Enumeration Date	:	10/01/2021
Last Update Date	:	10/01/2021

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