Provider Demographics
NPI:1831903210
Name:MORGAN, GEORGE MICHAEL (LMT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:MICHAEL
Last Name:MORGAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-3159
Mailing Address - Country:US
Mailing Address - Phone:312-543-4719
Mailing Address - Fax:
Practice Address - Street 1:306 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-3159
Practice Address - Country:US
Practice Address - Phone:312-543-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00724225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist