Provider Demographics
NPI:1710107495
Name:MORRISON, DONNA ERLYNE (LMT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:ERLYNE
Last Name:MORRISON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4908 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-3429
Mailing Address - Country:US
Mailing Address - Phone:817-320-6818
Mailing Address - Fax:
Practice Address - Street 1:522 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6505
Practice Address - Country:US
Practice Address - Phone:817-280-0886
Practice Address - Fax:817-280-0886
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT041286225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist