Provider Demographics
NPI:1689320285
Name:MATHENY, MORGAN JEAN
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:JEAN
Last Name:MATHENY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002-9313
Mailing Address - Country:US
Mailing Address - Phone:724-322-9310
Mailing Address - Fax:
Practice Address - Street 1:120 HOLLYWOOD DR STE 202
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-7604
Practice Address - Country:US
Practice Address - Phone:724-287-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG012654225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist