Healthcare Provider Details

I. General information

NPI: 1932783685
Provider Name (Legal Business Name): PAUL XAVIER MORRISON PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11902 BLUE RIDGE EXT STE 11906-B
GRANDVIEW MO
64030-1100
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 816-298-6120
  • Fax: 816-298-6423
Mailing address:
  • Phone: 423-238-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2021002434
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: