Provider Demographics
NPI:1497418560
Name:BLODGETT, MORGAN BETHANNE (DPT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:BETHANNE
Last Name:BLODGETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:BETHANNE
Other - Last Name:PERRIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4079 TONGASS
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5559
Mailing Address - Country:US
Mailing Address - Phone:907-225-7808
Mailing Address - Fax:907-247-7868
Practice Address - Street 1:4079 TONGASS
Practice Address - Street 2:SUITE 102
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5559
Practice Address - Country:US
Practice Address - Phone:907-225-7808
Practice Address - Fax:907-247-7868
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY047758225100000X
MD28707225100000X
CA303979225100000X
AK188544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1497418560Medicaid
MD1497418560Medicaid
CA1497418560Medicaid