Provider Demographics
NPI:1114192598
Name:MORGAN, CONNIE KRISTINA (MSPT)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:KRISTINA
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S 2ND AVE
Mailing Address - Street 2:PO BOX 1398
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4116
Mailing Address - Country:US
Mailing Address - Phone:509-527-8272
Mailing Address - Fax:509-527-8181
Practice Address - Street 1:1025 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4116
Practice Address - Country:US
Practice Address - Phone:509-527-8272
Practice Address - Fax:509-527-8181
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist