Provider Demographics
NPI:1932098407
Name:WALLACE, MORGAN (PT)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:WALLACE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:SCHABER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:563 PARK MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1225
Mailing Address - Country:US
Mailing Address - Phone:330-690-4774
Mailing Address - Fax:
Practice Address - Street 1:4041 HERITAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-2883
Practice Address - Country:US
Practice Address - Phone:330-665-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT019372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist