Provider Demographics
NPI:1194817429
Name:MORGAN, BRUCE ALAN (PT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALAN
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7870 W US HIGHWAY 290 APT 4201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-1918
Mailing Address - Country:US
Mailing Address - Phone:817-584-6122
Mailing Address - Fax:
Practice Address - Street 1:7900 FM 1826
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-1407
Practice Address - Country:US
Practice Address - Phone:817-584-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D3142Medicare ID - Type UnspecifiedDALLAS MEDICARE
TX8D3143Medicare ID - Type UnspecifiedTARRANT MEDICARE
TX00129YMedicare ID - Type UnspecifiedBEDFORD GROUP MEDICARE
TX00322YMedicare ID - Type UnspecifiedIRVING GROUP MEDICARE