Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05010651A | IN |
N | 225100000X | Physical Therapist | 070-016986 | IL |
NPI | 1003047192 |
---|---|
Provider Name | Matthew Morley I |
First Address | Oak Brook, IL 60523-8813 |
Second Address | Munster, IN 46321-1215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 27/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01054941 | MEDICARE RAILROAD (01) | IN |