Provider Demographics
NPI:1184006371
Name:MORELOCK, ALLEN (PTA)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:MORELOCK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:GIBSONBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43431-1236
Mailing Address - Country:US
Mailing Address - Phone:419-307-5562
Mailing Address - Fax:
Practice Address - Street 1:1330 FULTON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-9297
Practice Address - Country:US
Practice Address - Phone:419-734-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04124225200000X
PATEI005312225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant