Provider Demographics
NPI:1063633303
Name:MORRISON, BEVERLY E (PT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:E
Last Name:MORRISON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:TOLODZIECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1102 N BRAZOSPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:77541-3504
Mailing Address - Country:US
Mailing Address - Phone:979-233-6571
Mailing Address - Fax:
Practice Address - Street 1:1102 N BRAZOSPORT BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-3504
Practice Address - Country:US
Practice Address - Phone:979-233-6571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1160440208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1160440OtherLICENSED PHYSICAL THERAPI