Provider Demographics
NPI:1982131066
Name:CLARK, MORGAN LEE (DPT)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LEE
Last Name:CLARK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:LEE
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:668 SE BAYBERRY LN STE 105
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4366
Mailing Address - Country:US
Mailing Address - Phone:816-434-5180
Mailing Address - Fax:816-286-4112
Practice Address - Street 1:668 SE BAYBERRY LN STE 105
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4366
Practice Address - Country:US
Practice Address - Phone:816-434-5180
Practice Address - Fax:816-286-4112
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017030848225100000X
KS11-05628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist