Provider Demographics
NPI:1245763473
Name:STEFANIK, MORGAN (ATC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:STEFANIK
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 FOX TROT DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-6487
Mailing Address - Country:US
Mailing Address - Phone:607-742-4196
Mailing Address - Fax:
Practice Address - Street 1:CALIFORNIA RD
Practice Address - Street 2:BUILDING 7940
Practice Address - City:FORT CAMPBELL
Practice Address - State:TN
Practice Address - Zip Code:37042
Practice Address - Country:US
Practice Address - Phone:607-742-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN29372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program