Provider Demographics
NPI:1730160995
Name:MORGAN, PAMELA A (MSPT CCM)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MSPT CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 YELLOW WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-7126
Mailing Address - Country:US
Mailing Address - Phone:304-255-2376
Mailing Address - Fax:304-255-7120
Practice Address - Street 1:9 YELLOW WOOD WAY
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-7126
Practice Address - Country:US
Practice Address - Phone:304-255-2376
Practice Address - Fax:304-255-7120
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0157063000Medicaid
M00836481Medicare ID - Type Unspecified
MO0836482Medicare ID - Type Unspecified