Provider Demographics
NPI:1568191500
Name:MORRISSEY, MARY CHRISTINA (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:CHRISTINA
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 NIKE BASE RD
Mailing Address - Street 2:
Mailing Address - City:CATAWISSA
Mailing Address - State:MO
Mailing Address - Zip Code:63015-1269
Mailing Address - Country:US
Mailing Address - Phone:785-806-9590
Mailing Address - Fax:
Practice Address - Street 1:777 S NEW BALLAS RD STE 218E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8718
Practice Address - Country:US
Practice Address - Phone:314-991-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist