Provider Demographics
NPI:1518628106
Name:ST HENRY, MORGAN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:ST HENRY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2084 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-2264
Mailing Address - Country:US
Mailing Address - Phone:248-496-4709
Mailing Address - Fax:
Practice Address - Street 1:57850 VAN DYKE RD STE 200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3821
Practice Address - Country:US
Practice Address - Phone:586-992-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010023252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer