Healthcare Provider Details

I. General information

NPI: 1366056012
Provider Name (Legal Business Name): KAILEE ANNE MORRISON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E COPELAND RD STE 300
ARLINGTON TX
76011-4910
US

IV. Provider business mailing address

8605 ELLIS DR UNIT 1
WEATHERFORD TX
76088-4239
US

V. Phone/Fax

Practice location:
  • Phone: 817-505-2575
  • Fax:
Mailing address:
  • Phone: 817-694-4998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2154380
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: