Healthcare Provider Details

I. General information

NPI: 1417917402
Provider Name (Legal Business Name): TERESA R MORGAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 BENJAMIN WAY #304
DALTON GA
30721
US

IV. Provider business mailing address

515 BENJAMIN WAY #304
DALTON GA
30721
US

V. Phone/Fax

Practice location:
  • Phone: 706-278-8066
  • Fax: 706-278-8170
Mailing address:
  • Phone: 706-278-8066
  • Fax: 706-278-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001019
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: