Healthcare Provider Details

I. General information

NPI: 1386288991
Provider Name (Legal Business Name): MORGAN ESPINO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W SPRUCE ST
RAWLINS WY
82301-5335
US

IV. Provider business mailing address

1102 W SPRUCE ST
RAWLINS WY
82301-5335
US

V. Phone/Fax

Practice location:
  • Phone: 307-370-9175
  • Fax:
Mailing address:
  • Phone: 307-370-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPTA-0988
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: