Healthcare Provider Details

I. General information

NPI: 1285697987
Provider Name (Legal Business Name): JENNY LYN MORTON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 SE SUMMIT CT
PULLMAN WA
99163-5519
US

IV. Provider business mailing address

420 SW MOUNTAIN VIEW ST
PULLMAN WA
99163-2177
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-5106
  • Fax: 509-334-5723
Mailing address:
  • Phone: 208-371-2177
  • Fax: 509-334-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009800
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: