Provider Demographics
NPI:1619568193
Name:MORISON, VICTORIA BREANNE (PTA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:BREANNE
Last Name:MORISON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N BALLARD ST
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:OK
Mailing Address - Zip Code:74854-2511
Mailing Address - Country:US
Mailing Address - Phone:405-802-9706
Mailing Address - Fax:
Practice Address - Street 1:410 N BALLARD ST
Practice Address - Street 2:
Practice Address - City:MAUD
Practice Address - State:OK
Practice Address - Zip Code:74854-2511
Practice Address - Country:US
Practice Address - Phone:405-802-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3072225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant