Provider Demographics
NPI:1710170600
Name:MORGAN, LORRAINE (PT, MS)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301
Mailing Address - Country:US
Mailing Address - Phone:217-222-6800
Mailing Address - Fax:217-222-0037
Practice Address - Street 1:3032 BROADWAY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301
Practice Address - Country:US
Practice Address - Phone:217-222-6800
Practice Address - Fax:217-222-0037
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007978225100000X
IL070-007978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4117OtherHAMP PROVIDER ID
IL7216OtherPERSONALCARE PROVIDER ID
IL203OtherBLUE CROSS PROVIDER ID
IL113326OtherHEALTHLINK PROVIDER ID
IL7216OtherPERSONALCARE PROVIDER ID