Provider Demographics
NPI:1679853667
Name:MORRIS, MICHELE R (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:R
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:R
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:15 APEX DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1282
Mailing Address - Country:US
Mailing Address - Phone:618-651-0444
Mailing Address - Fax:618-654-5439
Practice Address - Street 1:210 HARTMAN LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1779
Practice Address - Country:US
Practice Address - Phone:618-589-9000
Practice Address - Fax:618-589-9005
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.007467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist