Provider Demographics
NPI:1043710452
Name:MORGAN, LANDAN D (PT)
Entity Type:Individual
Prefix:
First Name:LANDAN
Middle Name:D
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 540640
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-0640
Mailing Address - Country:US
Mailing Address - Phone:801-987-8700
Mailing Address - Fax:
Practice Address - Street 1:1050 W ELM AVE STE 130
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2713
Practice Address - Country:US
Practice Address - Phone:541-567-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist