Healthcare Provider Details

I. General information

NPI: 1457273419
Provider Name (Legal Business Name): MORGAN BUSICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10106 DUPONT CIRCLE DR E
FORT WAYNE IN
46825-1639
US

IV. Provider business mailing address

7950 W JEFFERSON BLVD
FORT WAYNE IN
46804-4140
US

V. Phone/Fax

Practice location:
  • Phone: 260-479-2720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36004170A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: