Provider Demographics
NPI:1689914970
Name:MORGAN, STACIE N (PT)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:N
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2758
Mailing Address - Country:US
Mailing Address - Phone:479-968-2525
Mailing Address - Fax:479-968-2539
Practice Address - Street 1:3605 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-7377
Practice Address - Country:US
Practice Address - Phone:015-327-2235
Practice Address - Fax:501-327-1601
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK25312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR216120721Medicaid