Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003318858 |
---|---|
Provider Name | Andrew Morgan |
First Address | Louisville, KY 40241-2851 |
Second Address | Louisville, KY 40241-2851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 25/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007644 | KENTUCKY PT LICENSE NUMBER (01) | KY |