Healthcare Provider Details

I. General information

NPI: 1124380829
Provider Name (Legal Business Name): AMANDA MORGAN MORI B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2012
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 PALOMAS AVE NE STE C
ALBUQUERQUE NM
87109-5201
US

IV. Provider business mailing address

7849 TRAMWAY BLVD NE STE A
ALBUQUERQUE NM
87122-2529
US

V. Phone/Fax

Practice location:
  • Phone: 505-208-7551
  • Fax: 505-212-3867
Mailing address:
  • Phone: 505-485-4176
  • Fax: 505-212-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2026-0158
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: