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General NPI Number Information
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NPI Number | 1518628106
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Entity Type | Individual
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Provider Name | MORGAN ST HENRY LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 57850 VAN DYKE RD STE 200
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City | WASHINGTON
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State | MI
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Zip | 48094-3821
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Country | US
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Telephone | 586-992-0869
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Fax |
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Provider Business Mailing Address
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Address Line | 2084 HUNTINGTON DR
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City | LAKE ORION
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State | MI
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Zip | 48360-2264
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Country | US
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Telephone | 248-496-4709
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601002325
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License Number State | MI
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