Healthcare Provider Details

I. General information

NPI: 1447943113
Provider Name (Legal Business Name): MORGAN SAVANNAH PHENIX DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8434 CORCORAN RD
WILLOW SPRINGS IL
60480-1666
US

IV. Provider business mailing address

1255 S STATE ST UNIT 1601
CHICAGO IL
60605-3581
US

V. Phone/Fax

Practice location:
  • Phone: 708-467-0657
  • Fax:
Mailing address:
  • Phone: 573-263-4031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070027482
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: