Healthcare Provider Details

I. General information

NPI: 1831567247
Provider Name (Legal Business Name): MORGAN LEIGH KETTERLING PT, DPT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MORGAN LEIGH BERGER

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 COLORADO LN
BISMARCK ND
58503-5447
US

IV. Provider business mailing address

1620 PLAINS BND SE
MANDAN ND
58554-5720
US

V. Phone/Fax

Practice location:
  • Phone: 701-214-5379
  • Fax:
Mailing address:
  • Phone: 757-777-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: