Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1130706 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1130706 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1130706 | TX |
NPI | 1396734786 |
---|---|
Provider Name | Mr. Gwen Wilson Morgan |
First Address | Amarillo, TX 79106-2110 |
Second Address | Amarillo, TX 79106-2110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 04/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136182100 | FIRSTCARE/SWL&H (01) | TX |
8T6867 | BCBS (01) | TX |