Provider Demographics
NPI:1912183617
Name:MORRIS, SUSAN ANISSA (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANISSA
Last Name:MORRIS
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 1:312 GRAMMONT ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7457
Mailing Address - Country:US
Mailing Address - Phone:318-323-6603
Mailing Address - Fax:318-323-2935
Practice Address - Street 1:312 GRAMMONT ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7457
Practice Address - Country:US
Practice Address - Phone:318-323-6603
Practice Address - Fax:318-323-2935
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA001186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist