Healthcare Provider Details

I. General information

NPI: 1013105584
Provider Name (Legal Business Name): TERESA KAY MORRIS P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 N SALISBURY ST
WEST LAFAYETTE IN
47906-1431
US

IV. Provider business mailing address

4907 EASTBROOK DR
LAFAYETTE IN
47905-7880
US

V. Phone/Fax

Practice location:
  • Phone: 765-464-5135
  • Fax:
Mailing address:
  • Phone: 765-589-8773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06001203A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: