Provider Demographics
NPI:1417917402
Name:MORGAN, TERESA R (PTA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:R
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 BENJAMIN WAY
Mailing Address - Street 2:#304
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721
Mailing Address - Country:US
Mailing Address - Phone:706-278-8066
Mailing Address - Fax:706-278-8170
Practice Address - Street 1:515 BENJAMIN WAY
Practice Address - Street 2:#304
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721
Practice Address - Country:US
Practice Address - Phone:706-278-8066
Practice Address - Fax:706-278-8170
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant