Provider Demographics
NPI:1073943932
Name:MORGAN, LYDIA L (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:L
Last Name:MORGAN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9526 HAMPTON DR
Mailing Address - Street 2:#21
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2492
Mailing Address - Country:US
Mailing Address - Phone:309-242-5915
Mailing Address - Fax:
Practice Address - Street 1:8400 WICKER AVE
Practice Address - Street 2:ATTN: ATHLETIC TRAINING
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9710
Practice Address - Country:US
Practice Address - Phone:219-365-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0032932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer