MEDICARE: MR. PATRICK WAYNE MORRIS JR. MS, ATC, PES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	RT003734	PA

General Provider Information

NPI Number	:	1033171632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK WAYNE MORRIS JR. MS, ATC, PES

Provider Business Mailing Address
First Line	:	37 E MARKET ST
Second Line	:
City	:	MOUNT UNION
State	:	PA
Zip	:	17066-1357
Country	:	US
Telephone Number	:	570-660-3163
Fax Number	:

Provider Business Practice Location Address
First Line	:	RR 2 BOX 1124
Second Line	:
City	:	THREE SPRINGS
State	:	PA
Zip	:	17264-9730
Country	:	US
Telephone Number	:	814-447-5529
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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