Provider Demographics
NPI:1396734786
Name:MORGAN, GWEN WILSON (PT)
Entity type:Individual
Prefix:MR
First Name:GWEN
Middle Name:WILSON
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 MEDI PARK DR
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2110
Mailing Address - Country:US
Mailing Address - Phone:806-353-5425
Mailing Address - Fax:806-353-5445
Practice Address - Street 1:1901 MEDI PARK DR
Practice Address - Street 2:SUITE 1010
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-353-5425
Practice Address - Fax:806-353-5445
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11307062251X0800X, 2251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136182100OtherFIRSTCARE/SWL&H
TX8T6867OtherBCBS