Provider Demographics
NPI:1376636431
Name:MORRISSETTE, JON MICHAEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:MICHAEL
Last Name:MORRISSETTE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38600
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-1010
Mailing Address - Country:US
Mailing Address - Phone:704-504-2194
Mailing Address - Fax:
Practice Address - Street 1:10965 WINDS CROSSING DR STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-2400
Practice Address - Country:US
Practice Address - Phone:704-504-2194
Practice Address - Fax:704-504-2197
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2509769OtherMEDICARE NC
SCTH1743Medicaid
NC068C2OtherBCBS
NC205555042OtherCORVEL
NC195578OtherMEDCOST
NC7212120Medicaid