Provider Demographics
NPI:1104356534
Name:MCKILLIP, MORGAN (PTA)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:MCKILLIP
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 1:1006 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-4762
Mailing Address - Country:US
Mailing Address - Phone:765-524-4050
Mailing Address - Fax:
Practice Address - Street 1:400 INDUSTRIES RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1500
Practice Address - Country:US
Practice Address - Phone:765-935-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99079913A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant