Provider Demographics
NPI:1447598172
Name:MORGAN, JODI L
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12530 LAKELAND SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:DEEPWATER
Mailing Address - State:MO
Mailing Address - Zip Code:64740-8138
Mailing Address - Country:US
Mailing Address - Phone:417-644-2223
Mailing Address - Fax:417-644-2316
Practice Address - Street 1:12530 LAKELAND SCHOOL DR
Practice Address - Street 2:
Practice Address - City:DEEPWATER
Practice Address - State:MO
Practice Address - Zip Code:64740-8138
Practice Address - Country:US
Practice Address - Phone:417-644-2223
Practice Address - Fax:417-644-2316
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008027875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist