Healthcare Provider Details

I. General information

NPI: 1073853107
Provider Name (Legal Business Name): MORGAN W MORRIS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN L WHITLOCK

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 SEVENTH STREET
DECATUR MS
39327
US

IV. Provider business mailing address

12490 ROAD 270
UNION MS
39365-7016
US

V. Phone/Fax

Practice location:
  • Phone: 601-635-4131
  • Fax:
Mailing address:
  • Phone: 601-416-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4979
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: