Provider Demographics
NPI:1740997428
Name:BROUGH, MORGAN CHRYSTINA
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:CHRYSTINA
Last Name:BROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 N 400 W
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-4107
Mailing Address - Country:US
Mailing Address - Phone:435-705-9098
Mailing Address - Fax:
Practice Address - Street 1:512 N 400 W
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-4107
Practice Address - Country:US
Practice Address - Phone:435-705-9098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer