MEDICARE: MR. THOMAS J MORGAN MS, LAT,ATC,PES,EMT

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	A0000157	MD
2	2255A2300X	Athletic Trainer	LAT2761	NC

General Provider Information

NPI Number	:	1407848070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS J MORGAN MS, LAT,ATC,PES,EMT

Provider Business Mailing Address
First Line	:	2024 KENSLEY DR.
Second Line	:
City	:	WAXHAW
State	:	NC
Zip	:	28173-8273
Country	:	US
Telephone Number	:	443-790-8078
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 CHESTNUT LN STE 120
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28104
Country	:	US
Telephone Number	:	704-893-5487
Fax Number	:	704-973-0696

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	05/21/2018

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