Provider Demographics
NPI:1760490056
Name:MORGAN, CHRISSIE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISSIE
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3871
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92628-3871
Mailing Address - Country:US
Mailing Address - Phone:949-366-3362
Mailing Address - Fax:949-366-3352
Practice Address - Street 1:1031 AVENIDA PICO STE 201
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6356
Practice Address - Country:US
Practice Address - Phone:949-366-3362
Practice Address - Fax:949-366-3352
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 20235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP20827Medicare UPIN
CAWPT20235AMedicare ID - Type Unspecified