Provider Demographics
NPI:1629324231
Name:MORRIS, SUSAN K (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 COLUMBIA CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2567
Mailing Address - Country:US
Mailing Address - Phone:618-281-9699
Mailing Address - Fax:618-281-9698
Practice Address - Street 1:880 COLUMBIA CTR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-2567
Practice Address - Country:US
Practice Address - Phone:618-281-9699
Practice Address - Fax:618-281-9698
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.003311225100000X
MOR0658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist