MEDICARE: LYDIA L. MORGAN ATC, LAT

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	096.003293	IL

General Provider Information

NPI Number	:	1073943932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA L. MORGAN ATC, LAT

Provider Business Mailing Address
First Line	:	9526 HAMPTON DR
Second Line	:	#21
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2492
Country	:	US
Telephone Number	:	309-242-5915
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 WICKER AVE
Second Line	:	ATTN: ATHLETIC TRAINING
City	:	SAINT JOHN
State	:	IN
Zip	:	46373-9710
Country	:	US
Telephone Number	:	219-365-8551
Fax Number	:

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

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	11/13/2013

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