Provider Demographics
NPI:1134525496
Name:MORTON, JANET KELLY I (LPTA)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:KELLY
Last Name:MORTON
Suffix:I
Gender:F
Credentials:LPTA
Other - Prefix:MISS
Other - First Name:JANET
Other - Middle Name:MARISA
Other - Last Name:KELLY
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:1216 WHITEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4216
Mailing Address - Country:US
Mailing Address - Phone:850-424-7483
Mailing Address - Fax:850-424-7483
Practice Address - Street 1:195 MATTIE KELLY BLVD
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2811
Practice Address - Country:US
Practice Address - Phone:850-654-4588
Practice Address - Fax:850-424-7483
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 1680225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA1680OtherLICENSE # PTA1680