Provider Demographics
NPI:1396081758
Name:MORGAN, LAURA (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MORGAN
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:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:GREEN MOUNTAIN FALLS
Mailing Address - State:CO
Mailing Address - Zip Code:80819-0753
Mailing Address - Country:US
Mailing Address - Phone:719-331-1011
Mailing Address - Fax:
Practice Address - Street 1:7265 CATAMOUNT ST
Practice Address - Street 2:
Practice Address - City:GREEN MOUNTAIN FALLS
Practice Address - State:CO
Practice Address - Zip Code:80819
Practice Address - Country:US
Practice Address - Phone:719-331-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist