Provider Demographics
NPI:1376912048
Name:MORGAN, VINCENT JOHN (PT,DPT,ATC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JOHN
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PT,DPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3165 S ALMA SCHOOL RD SUITE 30
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4426
Practice Address - Country:US
Practice Address - Phone:480-281-0414
Practice Address - Fax:480-885-1786
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11416PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist