MEDICARE: PAMELA J MORGAN P.T.

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	225100000X	Physical Therapist	PT1166	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	042407	OTHER	ME	BLUE SHIELD PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710073341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA J MORGAN P.T.

Provider Business Mailing Address
First Line	:	22 LINCOLN STREET
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011
Country	:	US
Telephone Number	:	207-729-1164
Fax Number	:	207-725-0905

Provider Business Practice Location Address
First Line	:	600 TURNER ST STE 2
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210-5093
Country	:	US
Telephone Number	:	207-707-4788
Fax Number	:	833-702-9005

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/07/2023

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