Provider Demographics
NPI:1841307063
Name:MORRIS, CHAD RENO (MPT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:RENO
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 4TH AVE
Mailing Address - Street 2:201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5716
Mailing Address - Country:US
Mailing Address - Phone:619-297-4404
Mailing Address - Fax:619-297-0804
Practice Address - Street 1:3200 4TH AVE
Practice Address - Street 2:201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5716
Practice Address - Country:US
Practice Address - Phone:619-297-4404
Practice Address - Fax:619-297-0804
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18268Medicare ID - Type Unspecified