Provider Demographics
NPI:1831567247
Name:KETTERLING, MORGAN LEIGH (PT, DPT, LAT, ATC)
Entity type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:LEIGH
Last Name:KETTERLING
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:MS
Other - First Name:MORGAN
Other - Middle Name:LEIGH
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1620 PLAINS BND SE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-5720
Mailing Address - Country:US
Mailing Address - Phone:757-777-2286
Mailing Address - Fax:
Practice Address - Street 1:3124 COLORADO LN
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5447
Practice Address - Country:US
Practice Address - Phone:701-214-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer