Healthcare Provider Details

I. General information

NPI: 1063633303
Provider Name (Legal Business Name): BEVERLY E MORRISON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BEVERLY TOLODZIECKI PT

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 N BRAZOSPORT BLVD
FREEPORT TX
77541-3504
US

IV. Provider business mailing address

1102 N BRAZOSPORT BLVD
FREEPORT TX
77541-3504
US

V. Phone/Fax

Practice location:
  • Phone: 979-233-6571
  • Fax:
Mailing address:
  • Phone: 979-233-6571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1160440
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: