Healthcare Provider Details

I. General information

NPI: 1548810682
Provider Name (Legal Business Name): MORGAN E. MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN E. BROWN

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 HORTON RD
JACKSON MI
49203-5524
US

IV. Provider business mailing address

2142 HORTON RD
JACKSON MI
49203-5524
US

V. Phone/Fax

Practice location:
  • Phone: 517-937-9155
  • Fax:
Mailing address:
  • Phone: 517-937-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502002763
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: