Provider Demographics
NPI:1245667815
Name:MORRISON, JENNIFER ANN (MSPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 W WILLOW TRACE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5744
Mailing Address - Country:US
Mailing Address - Phone:978-578-2350
Mailing Address - Fax:
Practice Address - Street 1:588 W WILLOW TRACE DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-5744
Practice Address - Country:US
Practice Address - Phone:978-578-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-3290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist