Provider Demographics
NPI:1114670767
Name:MORGAN, EVERA J (PTA)
Entity Type:Individual
Prefix:
First Name:EVERA
Middle Name:J
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15152 CAMPUS PARK DR APT A
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1516
Mailing Address - Country:US
Mailing Address - Phone:208-329-1241
Mailing Address - Fax:
Practice Address - Street 1:195 E HILLCREST DR STE 114
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5895
Practice Address - Country:US
Practice Address - Phone:818-318-2430
Practice Address - Fax:877-287-1195
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPTA48322225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant