Healthcare Provider Details

I. General information

NPI: 1992931570
Provider Name (Legal Business Name): THERESA ANN MORGAN IDMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 VOYAGER DR
SAN ANTONIO TX
78236-5637
US

IV. Provider business mailing address

4111 ANTLERS LODGE RD
SAN ANTONIO TX
78251-4300
US

V. Phone/Fax

Practice location:
  • Phone: 210-671-6041
  • Fax:
Mailing address:
  • Phone: 405-464-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: