Healthcare Provider Details

I. General information

NPI: 1912342189
Provider Name (Legal Business Name): MORGAN FRY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 CORRALES RD NW STE I
ALBUQUERQUE NM
87114-9255
US

IV. Provider business mailing address

10700 CORRALES RD NW STE I
ALBUQUERQUE NM
87114-9255
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-0003
  • Fax: 505-890-3330
Mailing address:
  • Phone: 505-890-0003
  • Fax: 505-890-3330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5022
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4936671-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: