Provider Demographics
NPI:1396399259
Name:PUTNAM, MORGAN (DPT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 DEVEREUX CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7801
Mailing Address - Country:US
Mailing Address - Phone:678-325-9142
Mailing Address - Fax:
Practice Address - Street 1:4516 CHAMBLEE DUNWOODY RD # 22
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6202
Practice Address - Country:US
Practice Address - Phone:678-459-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist