Provider Demographics
NPI:1811568306
Name:CORONADO, MORGAN ELIZABETH (PT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:ELIZABETH
Last Name:CORONADO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:ELIZABETH
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:789 JUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-4840
Mailing Address - Country:US
Mailing Address - Phone:972-771-5731
Mailing Address - Fax:972-771-5786
Practice Address - Street 1:789 JUSTIN RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4840
Practice Address - Country:US
Practice Address - Phone:972-771-5731
Practice Address - Fax:972-771-5786
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1330887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133087OtherSTATE LICENSE PHYSICAL THERAPY