Provider Demographics
NPI:1417584038
Name:LEDERMAN, MORGAN (ATC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:LEDERMAN
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 1:10203 SADDLEBRED TRL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-8669
Mailing Address - Country:US
Mailing Address - Phone:630-624-6392
Mailing Address - Fax:
Practice Address - Street 1:10203 SADDLEBRED TRL
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-8669
Practice Address - Country:US
Practice Address - Phone:630-624-6392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960037992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer