Provider Demographics
NPI:1043827165
Name:BRACKIN, MORGAN (PTA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:BRACKIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 APRIL LN
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-6208
Mailing Address - Country:US
Mailing Address - Phone:409-673-9811
Mailing Address - Fax:
Practice Address - Street 1:705 HIGHWAY 418 W
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-3635
Practice Address - Country:US
Practice Address - Phone:409-385-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2155550208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2155550Medicaid