Provider Demographics
NPI:1538996525
Name:SISK, MORGAN DREW (LMBT13766)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:DREW
Last Name:SISK
Suffix:
Gender:M
Credentials:LMBT13766
Other - Prefix:MR
Other - First Name:MORGAN
Other - Middle Name:DREW
Other - Last Name:SISK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMBT 13766
Mailing Address - Street 1:18676 US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-4049
Mailing Address - Country:US
Mailing Address - Phone:910-821-1700
Mailing Address - Fax:
Practice Address - Street 1:18676 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-4049
Practice Address - Country:US
Practice Address - Phone:910-821-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13766225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist