Healthcare Provider Details

I. General information

NPI: 1619584737
Provider Name (Legal Business Name): DAVID MORSE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 STATE RD STE 7
SUMMERVILLE SC
29486-2802
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 843-303-9418
  • Fax: 843-303-9363
Mailing address:
  • Phone: 843-824-2183
  • Fax: 843-553-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10390
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: