Provider Demographics
NPI:1598316580
Name:MORGAN, JENNY (DPT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MORGAN
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 1:361 SW 50TH RD
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-8416
Mailing Address - Country:US
Mailing Address - Phone:417-214-4711
Mailing Address - Fax:
Practice Address - Street 1:128 W 10TH ST STE 5
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-1449
Practice Address - Country:US
Practice Address - Phone:417-214-4711
Practice Address - Fax:417-221-4262
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-22
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019021854225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO480142093Medicaid