MEDICARE: MR. MITCHELL PAUL MORGAN DPT

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	046465	NY

General Provider Information

NPI Number	:	1902405491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MITCHELL PAUL MORGAN DPT

Provider Business Mailing Address
First Line	:	8300 S STREET RD
Second Line	:
City	:	PORT BYRON
State	:	NY
Zip	:	13140-3355
Country	:	US
Telephone Number	:	315-224-1445
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 MAIN ST
Second Line	:
City	:	CAMDEN
State	:	NY
Zip	:	13316-1301
Country	:	US
Telephone Number	:	315-245-5286
Fax Number	:

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

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	08/09/2022

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