Healthcare Provider Details

I. General information

NPI: 1932382488
Provider Name (Legal Business Name): ANTHONY MORFORD ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 VALLEY VIEW DR
MOLINE IL
61265-6152
US

IV. Provider business mailing address

1625 24TH ST
MOLINE IL
61265-4147
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-3621
  • Fax:
Mailing address:
  • Phone: 630-470-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096.002521
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: