Provider Demographics
NPI:1134833593
Name:MORGAN, KEVIN (LMT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MORGAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MERRILL CREEK PKWY APT 12024
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-7145
Mailing Address - Country:US
Mailing Address - Phone:206-852-7042
Mailing Address - Fax:
Practice Address - Street 1:12506 18TH ST NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-8145
Practice Address - Country:US
Practice Address - Phone:425-334-5409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist