Provider Demographics
NPI:1548457310
Name:MORGAN PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:MORGAN PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MPS, PT
Authorized Official - Phone:315-458-5442
Mailing Address - Street 1:5740 S BAY RD
Mailing Address - Street 2:PO BOX 1488
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8652
Mailing Address - Country:US
Mailing Address - Phone:315-458-5442
Mailing Address - Fax:315-458-5490
Practice Address - Street 1:5740 S BAY RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8652
Practice Address - Country:US
Practice Address - Phone:315-458-5442
Practice Address - Fax:315-458-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20476261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0456Medicare PIN