Provider Demographics
NPI:1033565932
Name:PIKE, MORGAN LYNDELL (PTA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LYNDELL
Last Name:PIKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:LYNDELL
Other - Last Name:BUSSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:909 S PARK ST
Practice Address - Street 2:STE B
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4456
Practice Address - Country:US
Practice Address - Phone:770-834-8702
Practice Address - Fax:770-830-8106
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003621225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant