Healthcare Provider Details

I. General information

NPI: 1124552302
Provider Name (Legal Business Name): PHIL MOR FIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 11/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 BELMONT AVE STE C-D
WINDSOR MILL MD
21244-2552
US

IV. Provider business mailing address

1718 BELMONT AVE STE C-D
WINDSOR MILL MD MD
21244-2552
US

V. Phone/Fax

Practice location:
  • Phone: 201-736-4811
  • Fax:
Mailing address:
  • Phone: 201-736-4811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP MICHAEL MORGAN
Title or Position: OWNER
Credential: M.S. PSYD CANDIDATE
Phone: 201-736-4811