Provider Demographics
NPI:1619225604
Name:MORGAN, AMANDA NICOLE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:NICOLE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:ZULLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:382 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3115
Mailing Address - Country:US
Mailing Address - Phone:203-250-9663
Mailing Address - Fax:
Practice Address - Street 1:382 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3115
Practice Address - Country:US
Practice Address - Phone:203-250-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist