Provider Demographics
NPI:1073853107
Name:MORRIS, MORGAN W (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:W
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:L
Other - Last Name:WHITLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12490 ROAD 270
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MS
Mailing Address - Zip Code:39365-7016
Mailing Address - Country:US
Mailing Address - Phone:601-416-4674
Mailing Address - Fax:
Practice Address - Street 1:135 SEVENTH STREET
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:MS
Practice Address - Zip Code:39327
Practice Address - Country:US
Practice Address - Phone:601-635-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA4979225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant