Provider Demographics
NPI:1629324298
Name:MORRIS, PETER (PTA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102B WHITE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-1228
Mailing Address - Country:US
Mailing Address - Phone:401-315-5321
Mailing Address - Fax:
Practice Address - Street 1:176 EDDIE DOWLING HWY
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-8233
Practice Address - Country:US
Practice Address - Phone:401-597-5665
Practice Address - Fax:401-597-5667
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
RIPTA00888225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant