Healthcare Provider Details

I. General information

NPI: 1558191627
Provider Name (Legal Business Name): MORGAN LOCKLEAR ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN DORSEY

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GREENDEVIL LN
DAYTON KY
41074-1200
US

IV. Provider business mailing address

3116 TROY AVE
CINCINNATI OH
45213-1320
US

V. Phone/Fax

Practice location:
  • Phone: 859-292-7486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT1127
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: