Provider Demographics
NPI:1952064495
Name:FLORES, MORGAN EMMONS
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:EMMONS
Last Name:FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12545 RIATA VISTA CIR # 578
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-6524
Mailing Address - Country:US
Mailing Address - Phone:512-526-1776
Mailing Address - Fax:512-298-1277
Practice Address - Street 1:5505 W PARMER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-4020
Practice Address - Country:US
Practice Address - Phone:512-526-1776
Practice Address - Fax:512-298-1277
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
820485224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
820485OtherAMERICAN COLLEGE OF SPORTS MEDICINE