Healthcare Provider Details

I. General information

NPI: 1780025486
Provider Name (Legal Business Name): DANIEL MORRISON ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ANDREW AVE 422
LA PORTE IN
46350-6543
US

IV. Provider business mailing address

2400 ANDREW AVE 422
LA PORTE IN
46350-6543
US

V. Phone/Fax

Practice location:
  • Phone: 616-915-6652
  • Fax:
Mailing address:
  • Phone: 616-915-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126001523
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: