Healthcare Provider Details

I. General information

NPI: 1780244475
Provider Name (Legal Business Name): MEGAN REANE MORRIS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2019
Last Update Date: 06/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 HICKORY RIDGE RD
WADDY KY
40076-7917
US

IV. Provider business mailing address

4930 HICKORY RIDGE RD
WADDY KY
40076-7917
US

V. Phone/Fax

Practice location:
  • Phone: 618-731-0153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA03878
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: