Provider Demographics
NPI:1386662385
Name:MORSE, ELEANOR (MS, ATC, NASM-PES)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:MORSE
Suffix:
Gender:F
Credentials:MS, ATC, NASM-PES
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:MORSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, ATC, NASM-PES
Mailing Address - Street 1:121 GROVE ST APT 9
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4535
Mailing Address - Country:US
Mailing Address - Phone:661-204-2051
Mailing Address - Fax:
Practice Address - Street 1:400 FENWAY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5725
Practice Address - Country:US
Practice Address - Phone:661-204-2051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1649OtherMASSACHUSETTES HEALTH CARE PROVIDER LICENSED ATHLETIC TRAINER