Provider Demographics
NPI:1912342189
Name:FRY, MORGAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:MORGAN
Middle Name:
Last Name:FRY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 CORRALES RD NW STE I
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-9255
Mailing Address - Country:US
Mailing Address - Phone:505-890-0003
Mailing Address - Fax:505-890-3330
Practice Address - Street 1:10700 CORRALES RD NW STE I
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-9255
Practice Address - Country:US
Practice Address - Phone:505-890-0003
Practice Address - Fax:505-890-3330
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5022225100000X
UT4936671-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist