Healthcare Provider Details

I. General information

NPI: 1619433505
Provider Name (Legal Business Name): COLTEN MORGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 W JESSE JAMES RD
EXCELSIOR SPRINGS MO
64024-1801
US

IV. Provider business mailing address

1761 W JESSE JAMES RD
EXCELSIOR SPRINGS MO
64024-1801
US

V. Phone/Fax

Practice location:
  • Phone: 417-343-6267
  • Fax:
Mailing address:
  • Phone: 816-630-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026008118
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: