Provider Demographics
NPI:1528327624
Name:MORGAN, JASON CORY (MS, LAT, ATC, PES)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:CORY
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MS, LAT, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8227 NORTHWEST BLVD
Mailing Address - Street 2:SUITE #160
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1387
Mailing Address - Country:US
Mailing Address - Phone:317-415-5795
Mailing Address - Fax:317-415-5748
Practice Address - Street 1:8227 NORTHWEST BLVD
Practice Address - Street 2:SUITE #160
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1387
Practice Address - Country:US
Practice Address - Phone:317-415-5795
Practice Address - Fax:317-415-5748
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001251A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer