MEDICARE: WYLISA LATRICE MORGAN LMT

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	225700000X	Massage Therapist	MSG007753	PA

General Provider Information

NPI Number	:	1902413131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYLISA LATRICE MORGAN LMT

Provider Business Mailing Address
First Line	:	2170 STRAHLE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2402
Country	:	US
Telephone Number	:	215-207-6987
Fax Number	:

Provider Business Practice Location Address
First Line	:	2170 STRAHLE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2402
Country	:	US
Telephone Number	:	215-207-6987
Fax Number	:

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

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	10/01/2020

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