Provider Demographics
NPI:1427043959
Name:MORRISON, PAMELA RAE (MSPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RAE
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N WESTERN AVE
Mailing Address - Street 2:#202
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1954
Mailing Address - Country:US
Mailing Address - Phone:847-234-1656
Mailing Address - Fax:
Practice Address - Street 1:500 N WESTERN AVE
Practice Address - Street 2:#202
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1954
Practice Address - Country:US
Practice Address - Phone:847-234-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4983032OtherBLUE CROSS BLUE SHIELD
IL210434Medicare ID - Type Unspecified