Provider Demographics
NPI:1275042889
Name:MORRICAL, AUDRIE E (LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:AUDRIE
Middle Name:E
Last Name:MORRICAL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:MS
Other - First Name:AUDRIE
Other - Middle Name:
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:5518 OLD DOVER BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-2840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5518 OLD DOVER BLVD APT 3
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-2840
Practice Address - Country:US
Practice Address - Phone:260-246-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer