Healthcare Provider Details

I. General information

NPI: 1740421676
Provider Name (Legal Business Name): LISA JO MORGAN CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SISKIN PLZ
CHATTANOOGA TN
37403-1306
US

IV. Provider business mailing address

1836 OAK COVE DR
SODDY DAISY TN
37379-5936
US

V. Phone/Fax

Practice location:
  • Phone: 423-634-1674
  • Fax:
Mailing address:
  • Phone: 423-451-0339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number18128
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: