Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | LPT-30662 | AZ |
NPI | 1033752902 |
---|---|
Provider Name | Morgan Marie Loss |
First Address | Phoenix, AZ 85014-2719 |
Second Address | Phoenix, AZ 85014-2719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2019 |
Last Update Date | 23/10/2019 |