Provider Demographics
NPI:1831720846
Name:BENGTZEN, MORGAN BREEANNA (ATC, LAT, MAL)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:BREEANNA
Last Name:BENGTZEN
Suffix:
Gender:F
Credentials:ATC, LAT, MAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 W LUSTERPOINTE LN
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5281
Mailing Address - Country:US
Mailing Address - Phone:801-702-7713
Mailing Address - Fax:
Practice Address - Street 1:701 E BOISE AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5119
Practice Address - Country:US
Practice Address - Phone:801-702-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty