Provider Demographics
NPI:1770579112
Name:MORGAN, ROBERT DENNIS (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DENNIS
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E BLITHEDALE AVE
Mailing Address - Street 2:STE C
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1478
Mailing Address - Country:US
Mailing Address - Phone:415-383-9670
Mailing Address - Fax:415-383-9675
Practice Address - Street 1:650 E BLITHEDALE AVE
Practice Address - Street 2:STE C
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1478
Practice Address - Country:US
Practice Address - Phone:415-383-9670
Practice Address - Fax:415-383-9675
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT75560Medicare ID - Type Unspecified