Provider Demographics
NPI:1992838544
Name:MORCOS, SALLY MICHEL (PT, DPT, PCS)
Entity Type:Individual
Prefix:MISS
First Name:SALLY
Middle Name:MICHEL
Last Name:MORCOS
Suffix:
Gender:F
Credentials:PT, DPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 E PAYSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2221
Mailing Address - Country:US
Mailing Address - Phone:909-576-5729
Mailing Address - Fax:
Practice Address - Street 1:359 E PAYSON ST
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2221
Practice Address - Country:US
Practice Address - Phone:909-576-5729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330492251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics