Provider Demographics
NPI:1356941405
Name:ALBERTSON, MORGAN (PT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:ALBERTSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36531 LADYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1703
Mailing Address - Country:US
Mailing Address - Phone:734-812-5094
Mailing Address - Fax:
Practice Address - Street 1:33000 ANNAPOLIS ST STE 210
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2920
Practice Address - Country:US
Practice Address - Phone:734-467-4134
Practice Address - Fax:734-467-4699
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501019458OtherMICHIGAN STATE BOARD OF PHYSICAL THERAPY